Provider Demographics
NPI:1497474035
Name:SOUL FOOD NEAR ME LLC
Entity Type:Organization
Organization Name:SOUL FOOD NEAR ME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-716-5426
Mailing Address - Street 1:4583 TACONY ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-4135
Mailing Address - Country:US
Mailing Address - Phone:484-716-5426
Mailing Address - Fax:
Practice Address - Street 1:4583 TACONY ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19124-4135
Practice Address - Country:US
Practice Address - Phone:484-716-5426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
No332U00000XSuppliersHome Delivered Meals