=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023441938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XALON HOME HEALTH SUPPLIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2013
-----------------------------------------------------
Last Update Date | 08/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 167 HARWINTON AVE APT 9
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-6564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-480-7713
-----------------------------------------------------
Fax | 860-201-1047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 474
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-0474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-480-7713
-----------------------------------------------------
Fax | 860-201-1047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. CHERI CHRISTIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-480-7713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1033641
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------