Healthcare Provider Details

I. General information

NPI: 1750186847
Provider Name (Legal Business Name): LVC C-CLASS REALTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 N MYRTLEWOOD ST
PHILADELPHIA PA
19132-3026
US

IV. Provider business mailing address

2640 N MYRTLEWOOD ST
PHILADELPHIA PA
19132-3041
US

V. Phone/Fax

Practice location:
  • Phone: 267-225-4360
  • Fax:
Mailing address:
  • Phone: 267-981-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: REGINALD CUMMINGS
Title or Position: CEO
Credential: R.PH., MBA
Phone: 267-225-4360