Provider Demographics
NPI:1063002970
Name:ADEMED SUPPLIES LLC
Entity Type:Organization
Organization Name:ADEMED SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:DIAZ
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-616-8367
Mailing Address - Street 1:6405 NW 36TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6977
Mailing Address - Country:US
Mailing Address - Phone:863-346-3627
Mailing Address - Fax:
Practice Address - Street 1:6405 NW 36TH ST STE 108
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6977
Practice Address - Country:US
Practice Address - Phone:863-346-3627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies