Provider Demographics
NPI:1497926109
Name:1 SOURCE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:1 SOURCE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSILAND
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FRIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-685-6505
Mailing Address - Street 1:6505 HARBOUR POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3181
Mailing Address - Country:US
Mailing Address - Phone:757-685-6505
Mailing Address - Fax:757-484-7429
Practice Address - Street 1:6505 HARBOUR POINTE DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3181
Practice Address - Country:US
Practice Address - Phone:757-685-6505
Practice Address - Fax:757-484-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA011511332B00000X, 332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies