Provider Demographics
NPI:1508981655
Name:CCE MEDICAL & NURSING SUPPLIES
Entity Type:Organization
Organization Name:CCE MEDICAL & NURSING SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:CARBAJAL
Authorized Official - Last Name:MASHTARE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:757-672-4288
Mailing Address - Street 1:4239 HOLLAND RD STE 784 PMB 669
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1941
Mailing Address - Country:US
Mailing Address - Phone:757-672-4288
Mailing Address - Fax:757-301-6348
Practice Address - Street 1:3217 BARLBOROUGH WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3050
Practice Address - Country:US
Practice Address - Phone:757-672-4288
Practice Address - Fax:757-301-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies