Provider Demographics
NPI:1982863676
Name:CHILDRESS INVESTMENTS, INC.
Entity Type:Organization
Organization Name:CHILDRESS INVESTMENTS, INC.
Other - Org Name:CHILDRESS ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:JERAL
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:909-930-1233
Mailing Address - Street 1:1240 E LOCUST ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-4546
Mailing Address - Country:US
Mailing Address - Phone:909-930-1233
Mailing Address - Fax:909-930-1230
Practice Address - Street 1:1240 E LOCUST ST
Practice Address - Street 2:SUITE 208
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-4546
Practice Address - Country:US
Practice Address - Phone:909-930-1233
Practice Address - Fax:909-930-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5996240001Medicare NSC