Provider Demographics
NPI:1336772003
Name:CRESTHAVEN MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:CRESTHAVEN MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:B(PHARM)
Authorized Official - Phone:614-600-1544
Mailing Address - Street 1:7735 HAVENS CT W
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9555
Mailing Address - Country:US
Mailing Address - Phone:614-600-1544
Mailing Address - Fax:
Practice Address - Street 1:2577 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4964
Practice Address - Country:US
Practice Address - Phone:614-600-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies