=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740907609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3R HOME IMPROVEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2022
-----------------------------------------------------
Last Update Date | 10/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1460 PENNSYLVANIA RD
-----------------------------------------------------
City | WYANDOTTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48192-7035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-389-9931
-----------------------------------------------------
Fax | 866-469-5869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1460 PENNSYLVANIA RD
-----------------------------------------------------
City | WYANDOTTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48192-7035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-389-9931
-----------------------------------------------------
Fax | 866-469-5869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. RONALD WILLIAM COX II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-671-5377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WH0202X
-----------------------------------------------------
Taxonomy Name | Home Modifications Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------