Healthcare Provider Details

I. General information

NPI: 1902190150
Provider Name (Legal Business Name): PSYCHE C-PAP PILLOW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LINNEY AVE
LOUISVILLE KY
40243-1014
US

IV. Provider business mailing address

208 LINNEY AVE
LOUISVILLE KY
40243-1014
US

V. Phone/Fax

Practice location:
  • Phone: 502-693-1037
  • Fax:
Mailing address:
  • Phone: 502-693-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD DEETSCH
Title or Position: PRESIDENT
Credential:
Phone: 502-693-1037