Basic Information
| Provider Information | |||||||||
| NPI: | 1326258104 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE TRAINING ROOM, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 611 | ||||||||
| Address2: | |||||||||
| City: | HAMPSTEAD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210740611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103744000 | ||||||||
| FaxNumber: | 4103745000 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210615884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103744000 | ||||||||
| FaxNumber: | 4103745000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOLESTA | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4103744000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ATC BOC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 02213418 | MD | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.