Provider Demographics
NPI:1851980007
Name:HOUSE OF SHEARS SUITES LLC
Entity Type:Organization
Organization Name:HOUSE OF SHEARS SUITES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WASTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-478-4169
Mailing Address - Street 1:5914 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2009
Mailing Address - Country:US
Mailing Address - Phone:513-462-9864
Mailing Address - Fax:
Practice Address - Street 1:5914 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2009
Practice Address - Country:US
Practice Address - Phone:513-462-9864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies