Organization
CERTICINE MEDICAL SUPPLY LLC
Active
Parent organization
PARK GRANDE HOLDINGS LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
PARK GRANDE HOLDINGS LTD
Authorized official
MR. BRANDON SLAVIK (MEMBER)
(949) 285-9796
Entity
Organization
Contact information
Practice address
700 SUNSET DR, #B, LA GRANDE, OR 97850-1260
(949) 285-9796
Mailing address
5331 SW MACADAM AVE, #214, PORTLAND, OR 97239-6104
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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