Provider Demographics
NPI:1578021168
Name:360 SUPPORT INC
Entity Type:Organization
Organization Name:360 SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:NWEPNSA
Authorized Official - Last Name:GOMIA
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:502-320-3624
Mailing Address - Street 1:300 MARDELLA DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-4766
Mailing Address - Country:US
Mailing Address - Phone:502-320-3624
Mailing Address - Fax:
Practice Address - Street 1:1629 K ST NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1631
Practice Address - Country:US
Practice Address - Phone:443-628-7736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care