Healthcare Provider Details

I. General information

NPI: 1093337305
Provider Name (Legal Business Name): SEW LUXE CUSTOMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8674 QUARTERS LAKE ROAD BUILDING 11 SUIT 1
BATON ROUGE LA
70809
US

IV. Provider business mailing address

10380 PERKINS RD UNIT 84232
BATON ROUGE LA
70884-5343
US

V. Phone/Fax

Practice location:
  • Phone: 225-485-7947
  • Fax: 985-275-8430
Mailing address:
  • Phone: 225-485-7947
  • Fax: 985-275-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DYNNISHEA JONES-MILLER
Title or Position: OWNER
Credential:
Phone: 225-485-7947