| NPI | 1740538883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MATUKEWICZ Secretary 423-756-2268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 171W00000X Contractor |
| 171WH0202X Contractor Home Modifications | |
| 171WV0202X Contractor Vehicle Modifications | |
| 251S00000X Community/Behavioral Health | |
| 261QD1600X Clinic/Center Developmental Disabilities | |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment | |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2024-03-19 |