Basic Information
| Provider Information | |||||||||
| NPI: | 1295728434 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SECOND WIND ENTERPRISES, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SECOND WIND RESPIRATORY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5221A MILITIA HILL RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109414555 | ||||||||
| FaxNumber: | 6109414557 | ||||||||
| Practice Location | |||||||||
| Address1: | 5221A MILITIA HILL RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109414555 | ||||||||
| FaxNumber: | 6109414557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 12/29/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | NAOMI | ||||||||
| AuthorizedOfficialMiddleName: | ROUFS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9496400330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 6376002 | 05 | NJ | MEDICAID | 000553316 | 05 | DE | MEDICAID | 01450528 | 05 | PA | MEDICAID |