Provider Demographics
NPI:1508490749
Name:MODIFICATION NETWORK, INC.
Entity Type:Organization
Organization Name:MODIFICATION NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:BOLOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-881-1616
Mailing Address - Street 1:17662 IRVINE BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3133
Mailing Address - Country:US
Mailing Address - Phone:714-881-1616
Mailing Address - Fax:
Practice Address - Street 1:17662 IRVINE BLVD STE 20
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3133
Practice Address - Country:US
Practice Address - Phone:714-881-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty