MEDICARE: MANOR RESPIRATORY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0000000769	TN
2	332BX2000X	Oxygen Equipment & Supplies (DME)	0000000769	TN

General Provider Information

NPI Number	:	1578575932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANOR RESPIRATORY CARE LLC

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:	615-424-4515
Fax Number	:

Provider Business Practice Location Address
First Line	:	3384 N MOUNT JULIET RD STE 400&500
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3192
Country	:	US
Telephone Number	:	615-773-1596
Fax Number	:	615-754-2582

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	06/09/2026

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