Healthcare Provider Details

I. General information

NPI: 1295728434
Provider Name (Legal Business Name): SECOND WIND ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221A MILITIA HILL RD
PLYMOUTH MEETING PA
19462-1216
US

IV. Provider business mailing address

5221A MILITIA HILL RD
PLYMOUTH MEETING PA
19462-1216
US

V. Phone/Fax

Practice location:
  • Phone: 610-941-4555
  • Fax: 610-941-4557
Mailing address:
  • Phone: 610-941-4555
  • Fax: 610-941-4557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. NAOMI ROUFS EDWARDS
Title or Position: OWNER/VICE PRESIDENT
Credential:
Phone: 949-640-0330