| Organization Name: | ANDALUSIA MANOR LLC |
| NPI Number: | 1407937709 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SAL-LEE SHA-REE SASSER (VICE-PRESIDENT) |
| Mailing Address: | 670 Moore Rd Andalusia |
| State: | AL US |
| Postal Code: | 36420 |
| Phone Number: | 3342224544 |
| Fax Number: | 3342224737 |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 02/11/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BP3500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Parenteral & Enteral Nutrition |
| Taxonomy Definition: | |