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General NPI Number Information
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NPI Number | 1407563216
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Entity Type | Organization
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Legal Business Name | HOOSIER HOME SYSTEMS LLC
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Dates
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Enumeration Date | 11/01/2022
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 6152 FIRE TOWER RD
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City | SALEM
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State | IN
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Zip | 47167
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Country | US
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Telephone | 425-367-1692
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1360
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City | STANWOOD
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State | WA
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Zip | 98292-1360
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Country | US
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Telephone | 425-367-1692
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONALD VEAZEY
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Credential |
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Telephone | 425-367-1692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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