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General NPI Number Information
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NPI Number | 1679385306
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Entity Type | Organization
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Legal Business Name | CROWNZ HEAVENLY PALACE LLC
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 712 H ST NE # 1509
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City | WASHINGTON
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State | DC
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Zip | 20002-3627
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Country | US
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Telephone | 771-210-4720
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Fax | 771-210-4720
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Provider Business Mailing Address
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Address Line | 712 H ST NE # 1509
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City | WASHINGTON
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State | DC
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Zip | 20002-3627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MIKAELAH GRANT
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Credential |
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Telephone | 410-900-7909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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