Provider Demographics
NPI:1285422741
Name:IGNITE RUN COLLECTIVE, LLC
Entity type:Organization
Organization Name:IGNITE RUN COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-523-0452
Mailing Address - Street 1:270 LAWRENCE PL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1068
Mailing Address - Country:US
Mailing Address - Phone:678-523-0452
Mailing Address - Fax:
Practice Address - Street 1:5829 CAMPBELLTON RD SW STE 102
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8036
Practice Address - Country:US
Practice Address - Phone:404-205-5877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies