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General NPI Number Information
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NPI Number | 1982001798
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Entity Type | Organization
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Legal Business Name | EDIBLE INDEPENDENCE INC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 397 WILBUR AVE
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City | KINGSTON
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State | NY
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Zip | 12401-6223
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Country | US
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Telephone | 845-331-6325
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Fax |
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Provider Business Mailing Address
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Address Line | 397 WILBUR AVE
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City | KINGSTON
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State | NY
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Zip | 12401-6223
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | MR. TABER MCNAUGHTON
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Credential |
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Telephone | 845-331-6325
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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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