Provider Demographics
NPI:1629173455
Name:NORCREST MEDICAL EQUIPMENT & SUPPLIES LLC
Entity Type:Organization
Organization Name:NORCREST MEDICAL EQUIPMENT & SUPPLIES LLC
Other - Org Name:LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ATTAESSIEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:UBOKUDOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-835-6884
Mailing Address - Street 1:15400 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-4124
Mailing Address - Country:US
Mailing Address - Phone:313-835-6884
Mailing Address - Fax:313-835-6895
Practice Address - Street 1:15400 GRAND RIVER AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-4124
Practice Address - Country:US
Practice Address - Phone:313-835-6884
Practice Address - Fax:313-835-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies