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General NPI Number Information
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NPI Number | 1568693083
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Entity Type | Organization
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Legal Business Name | MY HOME FOR LIFE
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 1300 BRANCHLANDS DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-1783
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Country | US
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Telephone | 434-977-6435
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 BRANCHLANDS DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-1783
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Country | US
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Telephone | 434-977-6435
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CHARLES IX
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Credential |
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Telephone | 434-977-6435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2400344
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License Number State | VA
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