Provider Demographics
NPI:1558642199
Name:INDIVIDUALITEA AND COFFEE COMPANY
Entity Type:Organization
Organization Name:INDIVIDUALITEA AND COFFEE COMPANY
Other - Org Name:INDIVIDUALITEA AND COFFEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-388-3848
Mailing Address - Street 1:2286 E CARSON ST
Mailing Address - Street 2:SP. 529
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3044
Mailing Address - Country:US
Mailing Address - Phone:562-388-3848
Mailing Address - Fax:562-422-8469
Practice Address - Street 1:14401 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5611
Practice Address - Country:US
Practice Address - Phone:714-544-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals