Provider Demographics
NPI:1720576150
Name:TINAS GIRLS LLC
Entity Type:Organization
Organization Name:TINAS GIRLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-372-2995
Mailing Address - Street 1:24 COLONELS DR APT 32
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2448
Mailing Address - Country:US
Mailing Address - Phone:617-372-2995
Mailing Address - Fax:
Practice Address - Street 1:24 COLONELS DR APT 32
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-2448
Practice Address - Country:US
Practice Address - Phone:617-372-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health