Provider Demographics
NPI:1558765081
Name:WARDEN ENTERPRISE, INC
Entity Type:Organization
Organization Name:WARDEN ENTERPRISE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-849-8034
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0746
Mailing Address - Country:US
Mailing Address - Phone:336-849-8034
Mailing Address - Fax:336-849-8006
Practice Address - Street 1:246 E MAIN ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8259
Practice Address - Country:US
Practice Address - Phone:336-849-8034
Practice Address - Fax:336-849-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies