Provider Demographics
NPI:1346662475
Name:C AND L SUPPORTIVE HEALTH MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:C AND L SUPPORTIVE HEALTH MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:423-330-6307
Mailing Address - Street 1:1001 N MAIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1576
Mailing Address - Country:US
Mailing Address - Phone:423-330-6307
Mailing Address - Fax:
Practice Address - Street 1:1001 N MAIN AVE STE B
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1576
Practice Address - Country:US
Practice Address - Phone:423-330-6307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies