Provider Demographics
NPI:1336709781
Name:ANDERSON WELLNESS SUPPLIES AND SERVICES, LLC
Entity Type:Organization
Organization Name:ANDERSON WELLNESS SUPPLIES AND SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:AVRON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSTEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-650-0337
Mailing Address - Street 1:777 S ALAMEDA ST FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-1657
Mailing Address - Country:US
Mailing Address - Phone:310-650-0337
Mailing Address - Fax:
Practice Address - Street 1:777 S ALAMEDA ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1657
Practice Address - Country:US
Practice Address - Phone:310-650-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies