Provider Demographics
NPI:1275660458
Name:LOCATEL STORES OPERATIONS, LLC
Entity Type:Organization
Organization Name:LOCATEL STORES OPERATIONS, LLC
Other - Org Name:LOCATEL HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-416-1219
Mailing Address - Street 1:1715 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4621
Mailing Address - Country:US
Mailing Address - Phone:954-416-1200
Mailing Address - Fax:954-416-1207
Practice Address - Street 1:1715 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4621
Practice Address - Country:US
Practice Address - Phone:954-416-1202
Practice Address - Fax:954-416-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH20154332BX2000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026988300Medicaid
FL5268630001Medicare NSC