Provider Demographics
NPI: | 1033735071 |
---|---|
Name: | PROVISION POINT LLC |
Entity Type: | Organization |
Organization Name: | PROVISION POINT LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DEBRINA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CRUSE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DME |
Authorized Official - Phone: | 215-207-1073 |
Mailing Address - Street 1: | 2560 BELMONT AVE APT 206B |
Mailing Address - Street 2: | |
Mailing Address - City: | PHILADELPHIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19131 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 215-207-1073 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2560 BELMONT AVE |
Practice Address - Street 2: | |
Practice Address - City: | PHILADELPHIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19131 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-207-1073 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | DEBRINA CRUSE |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2020-06-24 |
Last Update Date: | 2020-06-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | |
No | 332BD1200X | Suppliers | Durable Medical Equipment & Medical Supplies | Dialysis Equipment & Supplies |