Provider Demographics
NPI:1386821072
Name:FULLY CONFIDENT RESTWEAR INC.
Entity Type:Organization
Organization Name:FULLY CONFIDENT RESTWEAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ FITTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERREE
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO/CFM
Authorized Official - Phone:757-595-3488
Mailing Address - Street 1:4417 BRENT ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2528
Mailing Address - Country:US
Mailing Address - Phone:757-686-8338
Mailing Address - Fax:
Practice Address - Street 1:603 J CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE #4
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1826
Practice Address - Country:US
Practice Address - Phone:757-595-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8863142008332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6119460001Medicare NSC