Organization
SOLACE MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK BORNELEIT (SERVING EXECUTIVE OFFICER OWNER)
(225) 906-1594
Entity
Organization
Contact information
Practice address
1100 COMMERCIAL DR, PORT ALLEN, LA 70767-3224
(225) 906-1594
(225) 749-8943
Mailing address
1100 COMMERCIAL DR, PORT ALLEN, LA 70767-3224
(225) 906-1594
(225) 749-8943
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
17-0011509
LA
Other
Enumeration date
12/13/2006
Last updated
10/19/2012
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