Organization Name: | ACTIVE LIVING OSTOMY, INC |
NPI Number: | 1184736209 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GIRMA LEGGESSE (OWNER/PRESIDENT) |
Mailing Address: | 994 Thoroughbred Ln Norco |
State: | CA US |
Postal Code: | 928603861 |
Phone Number: | 9518089734 |
Fax Number: | 9518088603 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 11/27/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 009039 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |