Provider Demographics
NPI:1679234850
Name:DARE GREATLY TECH SYSTEMS LLC
Entity Type:Organization
Organization Name:DARE GREATLY TECH SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-865-6310
Mailing Address - Street 1:3331 RAINBOW DR. STE E #539
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906
Mailing Address - Country:US
Mailing Address - Phone:214-865-6310
Mailing Address - Fax:
Practice Address - Street 1:328 WILDWOOD ROAD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901
Practice Address - Country:US
Practice Address - Phone:214-865-6310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty