| NPI | 1861100638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NYDISHA BOYD Owner 267-253-7053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 172A00000X Driver |
| 302F00000X Exclusive Provider Organization | |
| 305R00000X Preferred Provider Organization | |
| 305S00000X Point of Service | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2023-08-17 |