Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Customized Equipment |
332BC3200X | 87 | All Other Suppliers |
| NPI # | 1518964949 |
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| LBN Legal business name | DEPARTMENT OF HUMAN SERVICES | ||||
| Authorized official | LISA BOATWRIGHT - (BUSINESS OFFICE MANAGER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 06/30/2005 | ||||
| Last updated | 08/07/2013 - About 13 years ago | ||||
| Identifiers |
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