Provider Demographics
NPI:1326348822
Name:PROFESSIONAL COMMUNITY BUSINESS
Entity Type:Organization
Organization Name:PROFESSIONAL COMMUNITY BUSINESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:RESPRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-270-9307
Mailing Address - Street 1:4135 RIVERS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-6633
Mailing Address - Country:US
Mailing Address - Phone:843-747-5997
Mailing Address - Fax:
Practice Address - Street 1:4135 RIVERS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-6633
Practice Address - Country:US
Practice Address - Phone:843-747-5997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty