| Organization Name: | SOLACE MEDICAL, LLC |
| NPI Number: | 1205997806 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK BORNELEIT (SERVING EXECUTIVE OFFICER OWNER) |
| Mailing Address: | 1100 Commercial Dr Port Allen |
| State: | LA US |
| Postal Code: | 707673224 |
| Phone Number: | 2259061594 |
| Fax Number: | 2257498943 |
| NPI Enumeration Date: | 12/13/2006 |
| NPI Last Update Date: | 10/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 17-0011509 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |