Provider Demographics
NPI:1164607230
Name:SWEET REFLECTIONS INC
Entity Type:Organization
Organization Name:SWEET REFLECTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-930-0139
Mailing Address - Street 1:12715 WARWICK BLVD
Mailing Address - Street 2:SUITE V
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1800
Mailing Address - Country:US
Mailing Address - Phone:757-930-0139
Mailing Address - Fax:757-930-4132
Practice Address - Street 1:12715 WARWICK BLVD
Practice Address - Street 2:SUITE V
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1800
Practice Address - Country:US
Practice Address - Phone:757-930-0139
Practice Address - Fax:757-930-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1096040001Medicare NSC