Provider Demographics
NPI:1033563770
Name:MODERN CARE MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:MODERN CARE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLUTAYO
Authorized Official - Middle Name:OLUMAYOWA
Authorized Official - Last Name:OLUKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-243-8199
Mailing Address - Street 1:3780 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3610
Mailing Address - Country:US
Mailing Address - Phone:203-870-8987
Mailing Address - Fax:203-870-8988
Practice Address - Street 1:3780 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3610
Practice Address - Country:US
Practice Address - Phone:203-870-8987
Practice Address - Fax:203-870-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1216892332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies