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General NPI Number Information
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NPI Number | 1689928004
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Entity Type | Organization
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Legal Business Name | ILS MEDICAL, INC
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 3612 PRUDEN BLVD STE B
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City | SUFFOLK
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State | VA
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Zip | 23434-7204
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Country | US
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Telephone | 877-571-1821
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Fax |
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Provider Business Mailing Address
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Address Line | 2085 LYNNHAVEN PKWY STE 106-253
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-1497
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Country | US
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Telephone | 877-581-1821
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ADMIN SERVICES
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Name | BRIAN G MOSS SR.
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Credential |
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Telephone | 877-581-1821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | VA
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