Provider Demographics
NPI:1194027441
Name:UNIVERSAL HOME MODIFICATIONS
Entity Type:Organization
Organization Name:UNIVERSAL HOME MODIFICATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-434-4846
Mailing Address - Street 1:29 FORUM SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3006
Mailing Address - Country:US
Mailing Address - Phone:314-434-4846
Mailing Address - Fax:
Practice Address - Street 1:29 FORUM SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3006
Practice Address - Country:US
Practice Address - Phone:314-434-4846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies