Provider Demographics
NPI:1164252631
Name:MEALS DIRECT OF MARYLAND LLC
Entity type:Organization
Organization Name:MEALS DIRECT OF MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVERGILIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-301-4162
Mailing Address - Street 1:3801 ARAMINGO AVE UNIT 27
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19137-1003
Mailing Address - Country:US
Mailing Address - Phone:215-613-6464
Mailing Address - Fax:717-918-5643
Practice Address - Street 1:8007 BAILEYS LN
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4633
Practice Address - Country:US
Practice Address - Phone:215-613-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No174200000XOther Service ProvidersMeals