Healthcare Provider Details

I. General information

NPI: 1477821452
Provider Name (Legal Business Name): KEN MAR HOME FURNISHINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US RT 6
MESHOPPEN PA
18630
US

IV. Provider business mailing address

PO BOX 99
MESHOPPEN PA
18630-0099
US

V. Phone/Fax

Practice location:
  • Phone: 570-833-5191
  • Fax: 570-833-2510
Mailing address:
  • Phone: 570-833-5191
  • Fax: 570-833-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberAPPLYING FOR
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. W KENNETH PRICE
Title or Position: OWNER/PARTNER
Credential: RETAILER
Phone: 570-833-5191