Organization
LOURDES HEALTH SUPPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL T CARELLI (EXECUTIVE DIRECTOR OF OPERATIONS)
(315) 458-3600
Entity
Organization
Contact information
Practice address
1155 FRONT ST, BINGHAMTON, NY 13905-1117
(607) 724-0115
(607) 724-0119
Mailing address
333 BUTTERNUT DR, SUITE 100, DE WITT, NY 13214-2141
(315) 458-3600
(315) 458-2760
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
7200000236
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2371222
—
NY
Enumeration date
06/13/2006
Last updated
11/05/2012
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