Provider Demographics
NPI:1295728434
Name:SECOND WIND ENTERPRISES, INC.
Entity type:Organization
Organization Name:SECOND WIND ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:ROUFS
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-640-0330
Mailing Address - Street 1:5221A MILITIA HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1216
Mailing Address - Country:US
Mailing Address - Phone:610-941-4555
Mailing Address - Fax:610-941-4557
Practice Address - Street 1:5221A MILITIA HILL RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1216
Practice Address - Country:US
Practice Address - Phone:610-941-4555
Practice Address - Fax:610-941-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6376002Medicaid
DE000553316Medicaid
PA01450528Medicaid
NJ6376002Medicaid