Provider Demographics
NPI:1093834020
Name:PURFOODS LLC DBA MOM'S MEALS
Entity Type:Organization
Organization Name:PURFOODS LLC DBA MOM'S MEALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-963-0641
Mailing Address - Street 1:3210 SE CORPORATE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-2502
Mailing Address - Country:US
Mailing Address - Phone:515-963-0641
Mailing Address - Fax:515-266-6120
Practice Address - Street 1:3210 SE CORPORATE WOODS DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2502
Practice Address - Country:US
Practice Address - Phone:515-963-0641
Practice Address - Fax:515-266-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0196501332U00000X, 332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102383905 001Medicaid
WY127458900Medicaid
OK200536020 AMedicaid
UT1093834020Medicaid
LA2163051Medicaid
OH2772316Medicaid
SCEX0951Medicaid
FL001653400Medicaid
AR189865753Medicaid
KS200629550AMedicaid
GA003105053AMedicaid
IN200925420AMedicaid
ND39839Medicaid
ID808321500Medicaid
CO88807550Medicaid
IA019650Medicaid
MT1093834020Medicaid
AZ274676Medicaid
TNH445168Medicaid
TXS500410290Medicaid
NV1093834020Medicaid
MN086462000Medicaid
MD6639038-00Medicaid
UT1093834020Medicaid