Healthcare Provider Details

I. General information

NPI: 1497387823
Provider Name (Legal Business Name): SONICLIFE.COM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 INDUSTRIAL SUITE C
HOOD RIVER OR
97031
US

IV. Provider business mailing address

P.O. BOX 1277 1027 INDUSTRIAL SUITE C
HOOD RIVER OR
97031
US

V. Phone/Fax

Practice location:
  • Phone: 541-490-5133
  • Fax: 541-436-0877
Mailing address:
  • Phone: 541-490-5133
  • Fax: 541-436-0877

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
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES G COLE
Title or Position: CEO
Credential:
Phone: 541-490-5133