Healthcare Provider Details

I. General information

NPI: 1124429642
Provider Name (Legal Business Name): CSSI HOLDINGS, LLC D/B/A ALPHA CARE SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 STRINGHAM AVE
VALLEY STREAM NY
11580-3915
US

IV. Provider business mailing address

21 STRINGHAM AVE
VALLEY STREAM NY
11580-3915
US

V. Phone/Fax

Practice location:
  • Phone: 516-568-3010
  • Fax: 516-256-3442
Mailing address:
  • Phone: 516-568-3010
  • Fax: 516-256-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHUNG H LEE
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-568-3010