Provider Demographics
NPI:1902973555
Name:COFFEE BEAN CAFE, LTD.
Entity type:Organization
Organization Name:COFFEE BEAN CAFE, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MONROE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERSONETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-593-1900
Mailing Address - Street 1:3804 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5256
Mailing Address - Country:US
Mailing Address - Phone:724-539-1900
Mailing Address - Fax:724-532-1464
Practice Address - Street 1:3804 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5256
Practice Address - Country:US
Practice Address - Phone:724-539-1900
Practice Address - Fax:724-532-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies