Healthcare Provider Details

I. General information

NPI: 1366992786
Provider Name (Legal Business Name): RICK IVENS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25560 BUSINESS PARK UNIT 2A
SEAFORD DE
19973-4292
US

IV. Provider business mailing address

25560 BUSINESS PARK UNIT 2A
SEAFORD DE
19973-4292
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-0200
  • Fax:
Mailing address:
  • Phone: 302-629-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number03-0000253
License Number StateDE

VIII. Authorized Official

Name: MRS. JANET L IVENS
Title or Position: VICE PRESIDENT
Credential:
Phone: 302-629-0200