Provider Demographics
NPI:1144989716
Name:WHITE PONY EXPRESS
Entity type:Organization
Organization Name:WHITE PONY EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-251-4174
Mailing Address - Street 1:3380 VINCENT RD STE 107
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4324
Mailing Address - Country:US
Mailing Address - Phone:925-322-0604
Mailing Address - Fax:
Practice Address - Street 1:3380 VINCENT RD STE 107
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4324
Practice Address - Country:US
Practice Address - Phone:925-322-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals