Provider Demographics
NPI:1639828692
Name:PINK WAVE CAPITAL LLC
Entity Type:Organization
Organization Name:PINK WAVE CAPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-309-0271
Mailing Address - Street 1:5234 N O CONNOR BLVD APT 3309
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5732
Mailing Address - Country:US
Mailing Address - Phone:469-309-0271
Mailing Address - Fax:
Practice Address - Street 1:1307 RIDGE RD # 119
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4301
Practice Address - Country:US
Practice Address - Phone:469-529-7179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment