Provider Demographics
NPI:1609542083
Name:SURVIVOR FRIENDLY LLC
Entity Type:Organization
Organization Name:SURVIVOR FRIENDLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROMITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-474-9336
Mailing Address - Street 1:20 DUKE MEDICINE CIRCLE
Mailing Address - Street 2:SELF IMAGE BOUTIQUE PROSTHETICS RM 0N14
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 DUKE MEDICINE CIRCLE
Practice Address - Street 2:SELF IMAGE BOUTIQUE PROSTHETICS RM 0N14
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-747-9336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURVIVOR FRIENDLY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment