Provider Demographics
NPI:1912009101
Name:RELIACARE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:RELIACARE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:FALZONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-746-4766
Mailing Address - Street 1:750 2ND ST NE STE 127
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8589
Mailing Address - Country:US
Mailing Address - Phone:952-746-4766
Mailing Address - Fax:752-746-4767
Practice Address - Street 1:750 2ND ST NE STE 127
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8589
Practice Address - Country:US
Practice Address - Phone:952-746-4766
Practice Address - Fax:752-746-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5618980001Medicare ID - Type Unspecified