Healthcare Provider Details

I. General information

NPI: 1598220022
Provider Name (Legal Business Name): SILLECT 360 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 ROSADO CT
BAKERSFIELD CA
93306-7477
US

IV. Provider business mailing address

5610 ROSADO CT
BAKERSFIELD CA
93306-7477
US

V. Phone/Fax

Practice location:
  • Phone: 661-706-9444
  • Fax:
Mailing address:
  • Phone: 661-706-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TY DANIEL HECKMAN
Title or Position: OWNER/CEO
Credential:
Phone: 661-706-9444