Provider Demographics
NPI:1790280576
Name:BETWEEN FOUR WALLS CORP
Entity Type:Organization
Organization Name:BETWEEN FOUR WALLS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OAKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-368-3115
Mailing Address - Street 1:540 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1862
Mailing Address - Country:US
Mailing Address - Phone:814-368-3115
Mailing Address - Fax:814-368-3115
Practice Address - Street 1:540 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1862
Practice Address - Country:US
Practice Address - Phone:814-368-3115
Practice Address - Fax:814-368-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies