Healthcare Provider Details

I. General information

NPI: 1427096916
Provider Name (Legal Business Name): INDEPENDANT LIFE STYLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 S AMHERST HWY
MADISON HEIGHTS VA
24572-2478
US

IV. Provider business mailing address

4880 S AMHERST HWY
MADISON HEIGHTS VA
24572-2478
US

V. Phone/Fax

Practice location:
  • Phone: 434-846-7510
  • Fax: 434-846-7189
Mailing address:
  • Phone: 434-846-7510
  • Fax: 434-846-7189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARRIE FRANCES WEEKS
Title or Position: GENERAL MANAGER/ OWNER
Credential:
Phone: 434-846-7510