Provider Demographics
NPI:1962220541
Name:PINKSLAYER COMMUNITY OUTREACH
Entity type:Organization
Organization Name:PINKSLAYER COMMUNITY OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:757-240-8127
Mailing Address - Street 1:1005 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4012
Mailing Address - Country:US
Mailing Address - Phone:757-240-8127
Mailing Address - Fax:
Practice Address - Street 1:3920A BRIDGE RD STE 305
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1126
Practice Address - Country:US
Practice Address - Phone:757-240-8127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health