Organization
MARY'S HEART HOME MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENNETT W. MORAIN (OWNER)
(337) 623-4109
Entity
Organization
Contact information
Practice address
226 LYONS ST, MELVILLE, LA 71353-0668
(337) 623-4109
(337) 623-4102
Mailing address
PO BOX 668, MELVILLE, LA 71353-0668
(337) 623-4109
(337) 623-4102
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
562576565
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1409081
—
LA
Enumeration date
07/01/2006
Last updated
05/01/2008
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