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General NPI Number Information
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NPI Number | 1750186847
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Entity Type | Organization
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Legal Business Name | LVC C-CLASS REALTY, LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 2539 N MYRTLEWOOD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19132-3026
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Country | US
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Telephone | 267-225-4360
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Fax |
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Provider Business Mailing Address
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Address Line | 2640 N MYRTLEWOOD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19132-3041
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Country | US
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Telephone | 267-981-7999
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | REGINALD CUMMINGS
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Credential | R.PH., MBA
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Telephone | 267-225-4360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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