Organization
JRSP CORPORATION
Active
Organization
JRSP CORPORATION
Active
Other names
LIFELINE MEDICAL & DIABETIC SUPPLY
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN MICHEAL PUSCIZNA (MANAGER OWNER)
(508) 646-6400
Entity
Organization
Contact information
Practice address
1211 GAR HWY, SWANSEA, MA 02777-4225
(508) 646-6400
Mailing address
122 HAILES HILL RD, SWANSEA, MA 02777-3604
(508) 646-6400
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1092840001
MA
332B00000X
Durable Medical Equipment & Medical Supplies
1538586
MA
332B00000X
Durable Medical Equipment & Medical Supplies
389254
MA
333600000X
Pharmacy
3369
MA
335E00000X
Prosthetic/Orthotic Supplier
1092840001
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538586
—
MA
01
—
3369
MASS PHARMACY LIC#
MA
01
—
389254
BCBS OF MASS PROVIDER #
MA
Enumeration date
07/13/2005
Last updated
04/05/2011
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