Provider Demographics
NPI:1982891743
Name:ENTERAL PRODUCTS, LLC
Entity type:Organization
Organization Name:ENTERAL PRODUCTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YISROEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RECHNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-447-2550
Mailing Address - Street 1:11333 GREENSTONE AVE
Mailing Address - Street 2:A
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4618
Mailing Address - Country:US
Mailing Address - Phone:562-447-2550
Mailing Address - Fax:562-968-5315
Practice Address - Street 1:11333 GREENSTONE AVE
Practice Address - Street 2:A
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4618
Practice Address - Country:US
Practice Address - Phone:562-447-2550
Practice Address - Fax:562-968-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1166332BP3500X
AZW002244332BP3500X
ARMG01187332BP3500X
CTCSW.0002888332BP3500X
IDDME18253332BP3500X
IL203001226332BP3500X
IN69000639A332BP3500X
KS16-00392332BP3500X
KYHME00304332BP3500X
LADME.000248332BP3500X
MDR3457332BP3500X
MI5306003903332BP3500X
MSF09620332BP3500X
MTPHA-WDD-LIC-1796332BP3500X
CA47578332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ535153Medicaid
NV1982891743Medicaid
LA2117548Medicaid
AL1982891743Medicaid
OH3095921Medicaid
MT1982891743Medicaid
CA1982891743 01Medicaid
WA1982891743Medicaid
UT1982891743Medicaid
AL1982891743Medicaid