| NPI | 1902399942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEZAREE' LUSK Owner 469-499-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 251E00000X Home Health |
| 251G00000X Hospice Care, Community Based | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 1744P3200X Specialist, Prosthetics Case Management (Licence: TX 1449535) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2025-04-30 |