Healthcare Provider Details

I. General information

NPI: 1528639374
Provider Name (Legal Business Name): PERFORMANCE KITCHEN, PBC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 N ORANGE ST
WILMINGTON DE
19801-1120
US

IV. Provider business mailing address

250 H STREET, PMB 4600
BLAINE WA
98230
US

V. Phone/Fax

Practice location:
  • Phone: 206-432-9849
  • Fax:
Mailing address:
  • Phone: 866-621-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: HEATHER MILLIGAN
Title or Position: SENIOR ACCOUNTANT
Credential:
Phone: 425-503-4603