Basic Information
| Provider Information | |||||||||
| NPI: | 1982873501 | ||||||||
| 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: | 8005001878 | ||||||||
| FaxNumber: | 4103745000 | ||||||||
| Practice Location | |||||||||
| Address1: | 4175 N HANSON CT STE 104 | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207163179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005001878 | ||||||||
| FaxNumber: | 4103745000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2008 | ||||||||
| LastUpdateDate: | 02/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | BOLESTA | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8005001878 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BOC ATC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 16272417 | MD | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.