Provider Demographics
NPI:1871632349
Name:ALLIANCE CONVALESCENT AND SURGICAL SUPPLY INC
Entity type:Organization
Organization Name:ALLIANCE CONVALESCENT AND SURGICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:GINYARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-526-2066
Mailing Address - Street 1:1217 BRENTWOOD RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1019
Mailing Address - Country:US
Mailing Address - Phone:202-526-2066
Mailing Address - Fax:
Practice Address - Street 1:1217 BRENTWOOD RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1019
Practice Address - Country:US
Practice Address - Phone:202-526-2066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCB159424332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0374800001Medicare ID - Type Unspecified