Provider Demographics
NPI:1083294532
Name:LONGE ENTERPRISES CORP
Entity Type:Organization
Organization Name:LONGE ENTERPRISES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRUEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-484-2691
Mailing Address - Street 1:3409 N ANTHONY BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-2283
Mailing Address - Country:US
Mailing Address - Phone:765-617-1890
Mailing Address - Fax:260-201-9194
Practice Address - Street 1:6413 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-1423
Practice Address - Country:US
Practice Address - Phone:765-617-1890
Practice Address - Fax:260-201-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier