Provider Demographics
NPI:1437463809
Name:VERSATILE RESOURCE LLC
Entity Type:Organization
Organization Name:VERSATILE RESOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNABELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRETO
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:760-431-1010
Mailing Address - Street 1:5751 PALMER WAY STE G8
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7249
Mailing Address - Country:US
Mailing Address - Phone:760-431-1010
Mailing Address - Fax:
Practice Address - Street 1:5751 PALMER WAY STE G8
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-7249
Practice Address - Country:US
Practice Address - Phone:760-431-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1228243332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies