Provider Demographics
NPI:1770109233
Name:AQUATINA MOBILE BATHING SERVICE, LLC
Entity type:Organization
Organization Name:AQUATINA MOBILE BATHING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-901-1119
Mailing Address - Street 1:PO BOX 12054
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 PHILLIPS CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-3820
Practice Address - Country:US
Practice Address - Phone:336-901-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care