Provider Demographics
NPI:1336381854
Name:COMFORT LIFE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:COMFORT LIFE MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MANAGEMENT
Authorized Official - Phone:954-564-3381
Mailing Address - Street 1:706 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2941
Mailing Address - Country:US
Mailing Address - Phone:954-564-3381
Mailing Address - Fax:954-564-3386
Practice Address - Street 1:4028 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6420
Practice Address - Country:US
Practice Address - Phone:954-564-3381
Practice Address - Fax:954-564-3386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFORDABLE SHOES LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6465110001OtherMEDICARE PTAN