1780357764 NPI number — 365 DME, LLC

Table of content: (NPI 1780357764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780357764 NPI number — 365 DME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
365 DME, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780357764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9860 HUDSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49271-9861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-997-5938
Provider Business Mailing Address Fax Number:
855-978-1450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9860 HUDSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49271-9861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-997-5938
Provider Business Practice Location Address Fax Number:
855-978-1450
Provider Enumeration Date:
07/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
ROBYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-997-5938

Provider Taxonomy Codes

  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 802631084 . This is a "ARTICLES OF INCORPORATION - STATE ID NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5306006880 . This is a "STATE OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: S62656 . This is a "BOC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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