Healthcare Provider Details

I. General information

NPI: 1912588989
Provider Name (Legal Business Name): CMCC FITNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 EDGEWOOD DR
NEW STANTON PA
15672-9795
US

IV. Provider business mailing address

150 EDGEWOOD DR
NEW STANTON PA
15672-9795
US

V. Phone/Fax

Practice location:
  • Phone: 412-930-4393
  • Fax:
Mailing address:
  • Phone: 412-930-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID G LORENZI
Title or Position: TERRITORY MANAGER
Credential: EDD
Phone: 724-689-9010