Provider Demographics
NPI:1336841394
Name:AGING STAR MEDICAL EQUIPMENT & SUPPLIES, INC
Entity Type:Organization
Organization Name:AGING STAR MEDICAL EQUIPMENT & SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-541-6945
Mailing Address - Street 1:123 NW 13TH ST STE 304-04
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1641
Mailing Address - Country:US
Mailing Address - Phone:561-372-9034
Mailing Address - Fax:561-372-9054
Practice Address - Street 1:123 NW 13TH ST STE 304-04
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1641
Practice Address - Country:US
Practice Address - Phone:561-372-9034
Practice Address - Fax:561-372-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies