Organization
LAUREL CREST DME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY J. MCMAHON (ASST. FINANCIAL OFFICER)
(814) 472-8100
Entity
Organization
Contact information
Practice address
429 MANOR DR, EBENSBURG, PA 15931-4917
(814) 472-8100
(814) 471-2131
Mailing address
429 MANOR DR, EBENSBURG, PA 15931-4917
(814) 472-8100
(814) 471-2131
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
6000004896
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016181920003
—
PA
Enumeration date
10/07/2005
Last updated
10/28/2008
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