Provider Demographics
NPI:1679785091
Name:DCB ENTERPRISE LLC
Entity type:Organization
Organization Name:DCB ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-360-7174
Mailing Address - Street 1:4935 WAGNER DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8816
Mailing Address - Country:US
Mailing Address - Phone:610-360-7174
Mailing Address - Fax:610-882-0621
Practice Address - Street 1:4935 WAGNER DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8816
Practice Address - Country:US
Practice Address - Phone:610-360-7174
Practice Address - Fax:610-882-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010827830002Medicaid
PA1010827830001Medicaid
PA1010827830002Medicaid