Provider Demographics
NPI:1972335396
Name:GIANT CABBAGE PROPERTIES LLC
Entity type:Organization
Organization Name:GIANT CABBAGE PROPERTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEROD
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-632-6204
Mailing Address - Street 1:11709 E KYROK CIR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7783
Mailing Address - Country:US
Mailing Address - Phone:907-632-6204
Mailing Address - Fax:
Practice Address - Street 1:267 S COBB ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6313
Practice Address - Country:US
Practice Address - Phone:907-632-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle