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Organization

SELF RELIANCE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MAGOMED KHAIDAKOV (PRESIDENT)
(501) 658-8057
Entity
Organization

Contact information

Practice address
500 S UNIVERSITY AVE, SUITE A-14, LITTLE ROCK, AR 72205-5302
(501) 671-6200
(501) 671-6205
Mailing address
500 S UNIVERSITY AVE, SUITE A-14, LITTLE ROCK, AR 72205-5302
(501) 671-6200
(501) 671-6205

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
175796716
AR
Enumeration date
06/09/2008
Last updated
03/31/2009
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