Provider Demographics
NPI:1053921353
Name:ICGRIT, LLC
Entity type:Organization
Organization Name:ICGRIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SULLIVAN
Authorized Official - Last Name:SALONE
Authorized Official - Suffix:
Authorized Official - Credentials:COPO
Authorized Official - Phone:661-874-8888
Mailing Address - Street 1:22543 VENTURA BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1403
Mailing Address - Country:US
Mailing Address - Phone:805-217-0252
Mailing Address - Fax:
Practice Address - Street 1:42304 COLUMBIA COURT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536
Practice Address - Country:US
Practice Address - Phone:805-217-0252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies