Provider Demographics
NPI:1316183072
Name:CLASSIC WAVE CORPORATION
Entity Type:Organization
Organization Name:CLASSIC WAVE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-304-9852
Mailing Address - Street 1:3815 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3935
Mailing Address - Country:US
Mailing Address - Phone:626-304-9852
Mailing Address - Fax:626-304-9872
Practice Address - Street 1:3815 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3935
Practice Address - Country:US
Practice Address - Phone:626-304-9852
Practice Address - Fax:626-304-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health