Provider Demographics
NPI:1134446016
Name:TOTAL CARE DIABETES, LLC
Entity type:Organization
Organization Name:TOTAL CARE DIABETES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:VEAUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-305-4978
Mailing Address - Street 1:3720 CURTIS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3961
Mailing Address - Country:US
Mailing Address - Phone:321-305-4978
Mailing Address - Fax:
Practice Address - Street 1:3720 CURTIS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-3961
Practice Address - Country:US
Practice Address - Phone:321-305-4978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6500110001Medicare NSC