Provider Demographics
NPI:1669470118
Name:NORTHSHORE RESPIRATORY AND REHAB SPECIALTIES, INC
Entity Type:Organization
Organization Name:NORTHSHORE RESPIRATORY AND REHAB SPECIALTIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-246-0040
Mailing Address - Street 1:220 W GERMANTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1437
Mailing Address - Country:US
Mailing Address - Phone:985-781-4050
Mailing Address - Fax:985-781-2345
Practice Address - Street 1:1222 FREMAUX AVE STE A
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8398
Practice Address - Country:US
Practice Address - Phone:985-781-4050
Practice Address - Fax:985-781-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACRT.LT1901332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7716301OtherAETNA
LA1100277Medicaid
MS00440889Medicaid
LA1100277Medicaid
LA4183290001Medicare NSC