Healthcare Provider Details

I. General information

NPI: 1699303941
Provider Name (Legal Business Name): COMPLETE CARE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BLUE RIDGE BLVD
NEWARK DE
19702-2979
US

IV. Provider business mailing address

3 BLUE RIDGE BLVD
NEWARK DE
19702-2979
US

V. Phone/Fax

Practice location:
  • Phone: 732-500-0612
  • Fax:
Mailing address:
  • Phone: 732-500-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ABIODUN SOBOWALE
Title or Position: OWNER
Credential:
Phone: 732-500-0612