Provider Demographics
NPI:1609056621
Name:CLN RETAIL ARDMORE, LLC
Entity Type:Organization
Organization Name:CLN RETAIL ARDMORE, LLC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-649-3112
Mailing Address - Street 1:28 RITTENHOUSE PL
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2227
Mailing Address - Country:US
Mailing Address - Phone:610-649-3112
Mailing Address - Fax:610-649-4355
Practice Address - Street 1:28 RITTENHOUSE PL
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2227
Practice Address - Country:US
Practice Address - Phone:610-649-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6032370001Medicare NSC