Provider Demographics
NPI:1801194618
Name:RONAELE
Entity type:Organization
Organization Name:RONAELE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LIAISON
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRISON
Authorized Official - Middle Name:ADELE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:253-223-0851
Mailing Address - Street 1:PO BOX 111073
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-1073
Mailing Address - Country:US
Mailing Address - Phone:253-223-0851
Mailing Address - Fax:
Practice Address - Street 1:8632 S ASOTIN ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-3174
Practice Address - Country:US
Practice Address - Phone:253-223-0851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies