Provider Demographics
NPI:1437638798
Name:SHORELINE HEARING LLC
Entity type:Organization
Organization Name:SHORELINE HEARING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:419-624-0336
Mailing Address - Street 1:4920 MILAN RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5899
Mailing Address - Country:US
Mailing Address - Phone:419-624-0336
Mailing Address - Fax:419-624-1757
Practice Address - Street 1:4920 MILAN RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5899
Practice Address - Country:US
Practice Address - Phone:419-624-0336
Practice Address - Fax:419-624-1757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment