Provider Demographics
NPI:1962872481
Name:CRIBS TO TEENS
Entity type:Organization
Organization Name:CRIBS TO TEENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:540-785-1440
Mailing Address - Street 1:3801 PLANK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7124
Mailing Address - Country:US
Mailing Address - Phone:540-785-1440
Mailing Address - Fax:540-785-1446
Practice Address - Street 1:3801 PLANK RD
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7124
Practice Address - Country:US
Practice Address - Phone:540-785-1440
Practice Address - Fax:540-785-1446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRIBS TO TEENS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-26
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment