MEDICARE: CRAFTMASTERS OF VIRGINIA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	2705035510	VA

General Provider Information

NPI Number	:	1245472950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAFTMASTERS OF VIRGINIA, INC.

Provider Business Mailing Address
First Line	:	2486 LOG CABIN RD
Second Line	:
City	:	MAIDENS
State	:	VA
Zip	:	23102-2224
Country	:	US
Telephone Number	:	804-556-4510
Fax Number	:	804-556-3290

Provider Business Practice Location Address
First Line	:	2486 LOG CABIN RD
Second Line	:
City	:	MAIDENS
State	:	VA
Zip	:	23102-2224
Country	:	US
Telephone Number	:	804-556-4510
Fax Number	:	804-556-3290

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ASHLEY MITCHELL HINES
Credential	:
Telephone Number	:	804-556-4510

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	03/26/2009

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