Provider Demographics
NPI:1932506847
Name:PRIDE REHABILITATIVE SOLUTIONS LLC
Entity Type:Organization
Organization Name:PRIDE REHABILITATIVE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:DEMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-520-4755
Mailing Address - Street 1:24 ELLMORE DR
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1010
Mailing Address - Country:US
Mailing Address - Phone:315-454-7980
Mailing Address - Fax:
Practice Address - Street 1:9546 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-2073
Practice Address - Country:US
Practice Address - Phone:732-299-6588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier