Basic Information
| Provider Information | |||||||||
| NPI: | 1801889563 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARESTED, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4686 | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087544686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323492990 | ||||||||
| FaxNumber: | 7322447588 | ||||||||
| Practice Location | |||||||||
| Address1: | 6619 PEARL RD | ||||||||
| Address2: | |||||||||
| City: | PARMA HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408427797 | ||||||||
| FaxNumber: | 4408883808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2005 | ||||||||
| LastUpdateDate: | 10/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | FRIED | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4408427797 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 125112 | OH | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BX2000X | 526649 | OH | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 0387077 | 05 | OH | MEDICAID |