Healthcare Provider Details

I. General information

NPI: 1669920260
Provider Name (Legal Business Name): WHEELY LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 FAIRWOOD DR
BROUSSARD LA
70518-4898
US

IV. Provider business mailing address

PO BOX 322
BROUSSARD LA
70518-0322
US

V. Phone/Fax

Practice location:
  • Phone: 337-552-4414
  • Fax:
Mailing address:
  • Phone:
  • 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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY HILL
Title or Position: TREASURER
Credential:
Phone: 337-552-4414