Organization
SLATE RIVER ENTERPRISES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FRATICELLI (SOLE PROPRIETOR)
(434) 996-2897
Entity
Organization
Contact information
Practice address
8954 S CONSTITUTION RTE, SCOTTSVILLE, VA 24590-5424
(434) 996-2897
Mailing address
8954 S CONSTITUTION RTE, SCOTTSVILLE, VA 24590-5424
(434) 996-2897
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2705090728
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2705090728
DEPARTMENT OF PROFESSIONAL AND OCCUPATIONAL REGULATION
VA
Enumeration date
05/26/2014
Last updated
05/26/2014
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