Provider Demographics
NPI:1801414321
Name:CRATE OF PAPAYA LLC
Entity Type:Organization
Organization Name:CRATE OF PAPAYA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CPSI
Authorized Official - Phone:972-740-7939
Mailing Address - Street 1:6320 WOODWAY LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7903
Mailing Address - Country:US
Mailing Address - Phone:972-740-7939
Mailing Address - Fax:
Practice Address - Street 1:6320 WOODWAY LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7903
Practice Address - Country:US
Practice Address - Phone:972-740-7939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center