| NPI | 1841240058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY RUSSALESI Cco 484-246-9499 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: PA 1000002763) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: PA 1000002763) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA 1000002763) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: PA 1000002763) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: PA 1000002763) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2025-10-14 |