Healthcare Provider Details

I. General information

NPI: 1194036384
Provider Name (Legal Business Name): SALA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N CAPITOL ST NW SHERMAN BUILDING
WASHINGTON DC
20011-8400
US

IV. Provider business mailing address

11728 BROOKEVILLE LANDING CT
BOWIE MD
20721-4504
US

V. Phone/Fax

Practice location:
  • Phone: 410-782-1122
  • Fax: 240-266-0573
Mailing address:
  • Phone: 410-782-1122
  • Fax: 240-266-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number350000073931
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number13852399
License Number StateMD

VIII. Authorized Official

Name: MR. ALONZO NIXON
Title or Position: VICE PRESIDENT
Credential:
Phone: 410-782-1122