Provider Demographics
NPI:1881378958
Name:ROBRICH ENTERPRISE LLC
Entity type:Organization
Organization Name:ROBRICH ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:662-251-5664
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:REFORM
Mailing Address - State:AL
Mailing Address - Zip Code:35481-0141
Mailing Address - Country:US
Mailing Address - Phone:662-251-5664
Mailing Address - Fax:
Practice Address - Street 1:105 4TH ST NW
Practice Address - Street 2:
Practice Address - City:REFORM
Practice Address - State:AL
Practice Address - Zip Code:35481-2351
Practice Address - Country:US
Practice Address - Phone:662-251-5664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639614563OtherINDIVIDUAL NPI