Provider Demographics
NPI:1659069581
Name:THE ORANGE RIBBON CLUB
Entity Type:Organization
Organization Name:THE ORANGE RIBBON CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:NCPSS
Authorized Official - Phone:980-441-9284
Mailing Address - Street 1:172 FLATBED DR # A
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-2187
Mailing Address - Country:US
Mailing Address - Phone:980-441-0314
Mailing Address - Fax:
Practice Address - Street 1:120 FAIRWAY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-2439
Practice Address - Country:US
Practice Address - Phone:980-441-0314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ORANGE RIBBON CLUB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-27
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty