Provider Demographics
NPI:1982887667
Name:COMMUNITY SUPPLY INC
Entity type:Organization
Organization Name:COMMUNITY SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VELDERRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-404-6172
Mailing Address - Street 1:2737 E GREENWAY RD
Mailing Address - Street 2:STE 11
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4391
Mailing Address - Country:US
Mailing Address - Phone:602-404-6172
Mailing Address - Fax:623-691-8095
Practice Address - Street 1:2737 E GREENWAY RD
Practice Address - Street 2:STE 11
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4391
Practice Address - Country:US
Practice Address - Phone:602-404-6172
Practice Address - Fax:623-691-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies