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General NPI Number Information
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NPI Number | 1750102026
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Entity Type | Organization
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Legal Business Name | AWESOME INCORPORATED
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 6020 53RD AVE S UNIT E
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City | FARGO
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State | ND
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Zip | 58104-5762
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Country | US
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Telephone | 701-356-5090
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Fax | 701-356-5091
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Provider Business Mailing Address
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Address Line | 6020 53RD AVE S UNIT E
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City | FARGO
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State | ND
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Zip | 58104-5762
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Country | US
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Telephone | 701-356-5090
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Fax | 701-356-5091
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Authorized Official
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Title or Position | PRESIDENT
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Name | GINA SCHUMACHER
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Credential |
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Telephone | 701-318-2133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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