Provider Demographics
NPI:1164886941
Name:FRESHAIRE CPAP & SUPPLIES, LLC
Entity Type:Organization
Organization Name:FRESHAIRE CPAP & SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:330-601-1991
Mailing Address - Street 1:2910 CLEVELAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1655
Mailing Address - Country:US
Mailing Address - Phone:330-601-1991
Mailing Address - Fax:330-601-1998
Practice Address - Street 1:2633 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1733
Practice Address - Country:US
Practice Address - Phone:330-601-1991
Practice Address - Fax:330-601-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3884884332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7550510001Medicare NSC