Healthcare Provider Details

I. General information

NPI: 1437379088
Provider Name (Legal Business Name): LANDERS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 PARADISE RD APT 502
ORRVILLE OH
44667-9421
US

IV. Provider business mailing address

1825 PARADISE RD APT 502
ORRVILLE OH
44667-9421
US

V. Phone/Fax

Practice location:
  • Phone: 330-642-0227
  • Fax:
Mailing address:
  • Phone: 330-682-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number85900034
License Number StateOH

VIII. Authorized Official

Name: TERRANCE LANDERS
Title or Position: OWNER
Credential:
Phone: 330-682-4571