Provider Demographics
NPI:1457699829
Name:BUBBLES BUBBLES BUBBLES,LLC
Entity Type:Organization
Organization Name:BUBBLES BUBBLES BUBBLES,LLC
Other - Org Name:EVERYBODY LOVES BUBBLES HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-993-9741
Mailing Address - Street 1:1535 ELLSWORTH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-3109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1535 ELLSWORTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-3109
Practice Address - Country:US
Practice Address - Phone:443-993-9741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUBBLES BUBBLES BUBBLES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-20
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service