Provider Demographics
NPI:1437867363
Name:PIEDMONT SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:PIEDMONT SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-406-0767
Mailing Address - Street 1:15831 GRIFFON PATH
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6661
Mailing Address - Country:US
Mailing Address - Phone:952-406-0767
Mailing Address - Fax:
Practice Address - Street 1:15831 GRIFFON PATH
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6661
Practice Address - Country:US
Practice Address - Phone:952-406-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health