Organization
101 DIABETIC SUPPLIES, LLC
Active
Other names
Jade Diabetic Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE GREYSLAK (MANAGING MEMBER)
(321) 267-7576
Entity
Organization
Contact information
Practice address
1400 WHITE DR STE B, TITUSVILLE, FL 32780-9657
(321) 676-8989
Mailing address
1400 WHITE DR STE B, TITUSVILLE, FL 32780-9657
(321) 676-8989
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/15/2011
Last updated
08/23/2013
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