Provider Demographics
NPI:1952014433
Name:MINOR EXPRESSIONS BIG MOMENTS LTD
Entity Type:Organization
Organization Name:MINOR EXPRESSIONS BIG MOMENTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:443-909-0982
Mailing Address - Street 1:6221 GREENLEIGH AVE UNIT 266
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2017
Mailing Address - Country:US
Mailing Address - Phone:443-909-0982
Mailing Address - Fax:
Practice Address - Street 1:6221 GREENLEIGH AVE UNIT 266
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-2017
Practice Address - Country:US
Practice Address - Phone:443-909-0982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health