Healthcare Provider Details

I. General information

NPI: 1548430705
Provider Name (Legal Business Name): BUDDY ENTERPRIZES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WARE BOTTOM SPRING RD STE 209
CHESTER VA
23836-2599
US

IV. Provider business mailing address

1601 WARE BOTTOM SPRING RD STE 209
CHESTER VA
23836-2599
US

V. Phone/Fax

Practice location:
  • Phone: 804-318-3826
  • Fax: 804-318-3833
Mailing address:
  • Phone: 804-318-3826
  • Fax: 804-318-3833

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0206009431
License Number StateVA

VIII. Authorized Official

Name: MRS. CYNTHIA ASHAUNTA CARNEY
Title or Position: CO OWNER
Credential:
Phone: 804-318-3826