Healthcare Provider Details

I. General information

NPI: 1497926109
Provider Name (Legal Business Name): 1 SOURCE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 HARBOUR POINTE DR
SUFFOLK VA
23435-3181
US

IV. Provider business mailing address

6505 HARBOUR POINTE DR
SUFFOLK VA
23435-3181
US

V. Phone/Fax

Practice location:
  • Phone: 757-685-6505
  • Fax: 757-484-7429
Mailing address:
  • Phone: 757-685-6505
  • Fax: 757-484-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number011511
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number011511
License Number StateVA

VIII. Authorized Official

Name: MRS. ROSILAND RENEE FRIDAY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 757-685-6505