Provider Demographics
NPI:1073115333
Name:A QUEENZ CROWN LLC
Entity Type:Organization
Organization Name:A QUEENZ CROWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NNEKI
Authorized Official - Middle Name:NONI
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-423-3090
Mailing Address - Street 1:479 CRESCENT ST APT 30
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2608
Mailing Address - Country:US
Mailing Address - Phone:510-423-3090
Mailing Address - Fax:
Practice Address - Street 1:460 EL CERRITO PLAZA
Practice Address - Street 2:SUITE 2
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530
Practice Address - Country:US
Practice Address - Phone:510-423-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment