Provider Demographics
NPI:1518096429
Name:EARTHWIND MEDICAL CO, LLC
Entity Type:Organization
Organization Name:EARTHWIND MEDICAL CO, LLC
Other - Org Name:HEALTHY ALTERNATIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BANAS
Authorized Official - Suffix:
Authorized Official - Credentials:LRCP
Authorized Official - Phone:814-684-7929
Mailing Address - Street 1:RR 3 BOX 158B
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-9526
Mailing Address - Country:US
Mailing Address - Phone:814-684-7929
Mailing Address - Fax:814-684-7804
Practice Address - Street 1:RR 3 BOX 158B
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-9526
Practice Address - Country:US
Practice Address - Phone:814-684-7929
Practice Address - Fax:814-684-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000005803332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018864240002Medicaid
PA0018864240002Medicaid