Provider Demographics
NPI:1942641410
Name:HEAVENLYNAILS
Entity Type:Organization
Organization Name:HEAVENLYNAILS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WOUND AND SKIN CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED
Authorized Official - Phone:214-641-6338
Mailing Address - Street 1:601 CYPRESS STATION DR
Mailing Address - Street 2:# 1406
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1507
Mailing Address - Country:US
Mailing Address - Phone:214-641-6338
Mailing Address - Fax:
Practice Address - Street 1:1406 CYPRESS STATION DR
Practice Address - Street 2:# 1406
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:214-641-6338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No253Z00000XAgenciesIn Home Supportive Care
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies