Provider Demographics
NPI:1588965552
Name:SELECT HOME CARE & DIABETIC SUPPLIES
Entity type:Organization
Organization Name:SELECT HOME CARE & DIABETIC SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-229-0117
Mailing Address - Street 1:7505 CARIBOU CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-9604
Mailing Address - Country:US
Mailing Address - Phone:980-229-0117
Mailing Address - Fax:
Practice Address - Street 1:7505 CARIBOU CT
Practice Address - Street 2:7505 CARIBOU CT
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-9604
Practice Address - Country:US
Practice Address - Phone:980-229-0117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies