Provider Demographics
NPI:1851147946
Name:TITAN ST ENTERPRISES, LLC
Entity type:Organization
Organization Name:TITAN ST ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:REINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-404-7384
Mailing Address - Street 1:920 LAWN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1560
Mailing Address - Country:US
Mailing Address - Phone:215-258-1090
Mailing Address - Fax:215-258-1091
Practice Address - Street 1:920 LAWN AVE STE 8
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1560
Practice Address - Country:US
Practice Address - Phone:215-258-1090
Practice Address - Fax:215-258-1091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TITAN ST ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental