Provider Demographics
NPI:1629757034
Name:COMMUNITY EXPO LLC
Entity Type:Organization
Organization Name:COMMUNITY EXPO LLC
Other - Org Name:BELOVED PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-312-2773
Mailing Address - Street 1:366 HIGH CREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-3740
Mailing Address - Country:US
Mailing Address - Phone:770-312-2773
Mailing Address - Fax:
Practice Address - Street 1:366 HIGH CREST DR
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-3740
Practice Address - Country:US
Practice Address - Phone:770-312-2773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health