Provider Demographics
NPI:1699303941
Name:COMPLETE CARE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:COMPLETE CARE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOWALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-500-0612
Mailing Address - Street 1:3 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2979
Mailing Address - Country:US
Mailing Address - Phone:732-500-0612
Mailing Address - Fax:
Practice Address - Street 1:3 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-2979
Practice Address - Country:US
Practice Address - Phone:732-500-0612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies