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General NPI Number Information
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NPI Number | 1649937236
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Entity Type | Organization
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Legal Business Name | TANGELO - INTEND, INC.
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 550 W MERRILL ST STE 100
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City | BIRMINGHAM
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State | MI
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Zip | 48009-1443
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Country | US
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Telephone | 503-936-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 550 W MERRILL ST STE 100
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City | BIRMINGHAM
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State | MI
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Zip | 48009-1443
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Country | US
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Telephone | 503-936-1400
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. CHRISTOPHER NATHAN O'CONNOR
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Credential |
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Telephone | 904-671-2995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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