Provider Demographics
NPI:1417951799
Name:LASALLE HEALTH SERVICE INC
Entity Type:Organization
Organization Name:LASALLE HEALTH SERVICE INC
Other - Org Name:ADVANTAGE HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-699-2090
Mailing Address - Street 1:652 E WASHINGTON ST
Mailing Address - Street 2:STE 2
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2488
Mailing Address - Country:US
Mailing Address - Phone:508-699-2090
Mailing Address - Fax:509-699-5932
Practice Address - Street 1:652 E WASHINGTON ST
Practice Address - Street 2:STE 2
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-2488
Practice Address - Country:US
Practice Address - Phone:508-699-2090
Practice Address - Fax:509-699-5932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0129750002Medicare NSC