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General NPI Number Information
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NPI Number | 1942641410
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Entity Type | Organization
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Legal Business Name | HEAVENLYNAILS
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Dates
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Enumeration Date | 07/12/2013
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Last Update Date | 07/12/2013
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Provider Practice Location Address
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Address Line | 1406 CYPRESS STATION DR # 1406
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City | HOUSTON
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State | TX
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Zip | 77090
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Country | US
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Telephone | 214-641-6338
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Fax |
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Provider Business Mailing Address
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Address Line | 601 CYPRESS STATION DR # 1406
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City | HOUSTON
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State | TX
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Zip | 77090-1507
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Country | US
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Telephone | 214-641-6338
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Fax |
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Authorized Official
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Title or Position | WOUND AND SKIN CARE
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Name | MS. VICKI ROCHELLE MARTIN
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Credential | LICENSED
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Telephone | 214-641-6338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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