Provider Demographics
NPI:1750075362
Name:FRESH FRUITS
Entity type:Organization
Organization Name:FRESH FRUITS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-398-5319
Mailing Address - Street 1:165 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-6010
Mailing Address - Country:US
Mailing Address - Phone:765-398-5319
Mailing Address - Fax:937-963-1222
Practice Address - Street 1:1101 N H ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2341
Practice Address - Country:US
Practice Address - Phone:937-838-5292
Practice Address - Fax:937-963-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company