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General NPI Number Information
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NPI Number | 1457788085
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Entity Type | Organization
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Legal Business Name | MEDISOURCE SOLUTIONS, LLC
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 325 FENTON RD SW
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City | PALM BAY
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State | FL
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Zip | 32908-4882
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Country | US
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Telephone | 321-506-5688
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Fax | 888-320-0905
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Provider Business Mailing Address
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Address Line | 325 FENTON RD SW
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City | PALM BAY
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State | FL
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Zip | 32908-4882
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Country | US
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Telephone | 321-506-5688
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Fax | 888-320-0905
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Authorized Official
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Title or Position | OWNER
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Name | KEVAN ALLAIRE SR.
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Credential |
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Telephone | 321-506-5688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1374
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License Number State | FL
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