Healthcare Provider Details

I. General information

NPI: 1609542083
Provider Name (Legal Business Name): SURVIVOR FRIENDLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 DUKE MEDICINE CIRCLE SELF IMAGE BOUTIQUE PROSTHETICS RM 0N14
DURHAM NC
27710-0001
US

IV. Provider business mailing address

20 DUKE MEDICINE CIRCLE SELF IMAGE BOUTIQUE PROSTHETICS RM 0N14
DURHAM NC
27710
US

V. Phone/Fax

Practice location:
  • Phone: 919-747-9336
  • 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: JACQUELINE CROMITY
Title or Position: OWNER
Credential:
Phone: 919-474-9336