Provider Demographics
NPI:1215911508
Name:DIABETIC SUPPLY FOUNDATION OF BELMONT, INC.
Entity type:Organization
Organization Name:DIABETIC SUPPLY FOUNDATION OF BELMONT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GENARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-609-7804
Mailing Address - Street 1:2835 ELM RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-2663
Mailing Address - Country:US
Mailing Address - Phone:330-609-7804
Mailing Address - Fax:
Practice Address - Street 1:2835 ELM RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-2663
Practice Address - Country:US
Practice Address - Phone:330-609-7804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH78070196332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53668301Medicaid
NC7701593Medicaid
OH0272502Medicaid
WV6201065000Medicaid
SCDMO596Medicaid
0729370001Medicare NSC