Organization
LIFE SUPPLY CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH SMITH (CEO PRESIDENT)
(203) 239-1002
Entity
Organization
Contact information
Practice address
280 MOODY ST, LUDLOW, MA 01056-1244
(413) 593-5555
(413) 593-9530
Mailing address
280 MOODY ST, LUDLOW, MA 01056-1244
(413) 593-5555
(413) 593-9530
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003104429
—
CT
05
—
1537687
—
MA
01
—
378354
BC BS PROVIDER NUMBER
MA
Enumeration date
05/23/2005
Last updated
01/24/2022
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