Healthcare Provider Details

I. General information

NPI: 1649106477
Provider Name (Legal Business Name): FOREVER CROWNED CRANIAL PROSTHESIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 N MAIN ST STE 1267
SUMMERVILLE SC
29483-7308
US

IV. Provider business mailing address

1318 N MAIN ST STE 1267
SUMMERVILLE SC
29483-7308
US

V. Phone/Fax

Practice location:
  • Phone: 888-688-1643
  • Fax:
Mailing address:
  • Phone: 888-688-1643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANIKA OLIVER
Title or Position: OWNER
Credential:
Phone: 888-688-1643