Provider Demographics
NPI: | 1346791621 |
---|---|
Name: | MCCANDLESS ENTERPRISES LLC |
Entity Type: | Organization |
Organization Name: | MCCANDLESS ENTERPRISES LLC |
Other - Org Name: | MIRACLE-EAR |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANANGING MEMBER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | STEPHANIE |
Authorized Official - Middle Name: | LYNNE |
Authorized Official - Last Name: | MCCANDLESS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MBA |
Authorized Official - Phone: | 304-612-4010 |
Mailing Address - Street 1: | 1400 JOHNSON AVE |
Mailing Address - Street 2: | SUITE 4N |
Mailing Address - City: | BRIDGEPORT |
Mailing Address - State: | WV |
Mailing Address - Zip Code: | 26330-1063 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 304-842-3050 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1400 JOHNSON AVE |
Practice Address - Street 2: | SUITE 4N |
Practice Address - City: | BRIDGEPORT |
Practice Address - State: | WV |
Practice Address - Zip Code: | 26330-1063 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-842-3050 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-20 |
Last Update Date: | 2016-10-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WV | 332S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332S00000X | Suppliers | Hearing Aid Equipment |