Provider Demographics
NPI:1194197780
Name:PELV-ICE LLC
Entity Type:Organization
Organization Name:PELV-ICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-927-3053
Mailing Address - Street 1:1118 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3212
Mailing Address - Country:US
Mailing Address - Phone:310-961-3626
Mailing Address - Fax:
Practice Address - Street 1:1118 MISSION ST
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3212
Practice Address - Country:US
Practice Address - Phone:310-961-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PELV-ICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies