Provider Demographics
NPI:1528639374
Name:PERFORMANCE KITCHEN, PBC
Entity type:Organization
Organization Name:PERFORMANCE KITCHEN, PBC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-503-4603
Mailing Address - Street 1:250 H STREET, PMB 4600
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230
Mailing Address - Country:US
Mailing Address - Phone:866-621-9029
Mailing Address - Fax:
Practice Address - Street 1:1209 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1120
Practice Address - Country:US
Practice Address - Phone:206-432-9849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No174200000XOther Service ProvidersMeals