Provider Demographics
NPI:1184995458
Name:A1DERFUL CORPORATION
Entity type:Organization
Organization Name:A1DERFUL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-201-1237
Mailing Address - Street 1:919 E 35TH AVE
Mailing Address - Street 2:1K
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1368
Mailing Address - Country:US
Mailing Address - Phone:217-201-1237
Mailing Address - Fax:
Practice Address - Street 1:919 E 35TH AVE
Practice Address - Street 2:1K
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-1368
Practice Address - Country:US
Practice Address - Phone:217-201-1237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle