Provider Demographics
NPI:1326913849
Name:A HAVEN OF HALOS LLC
Entity type:Organization
Organization Name:A HAVEN OF HALOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:SMITH
Authorized Official - Phone:843-730-3901
Mailing Address - Street 1:6650 RIVERS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4829
Mailing Address - Country:US
Mailing Address - Phone:843-730-3901
Mailing Address - Fax:
Practice Address - Street 1:202 3RD LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3795
Practice Address - Country:US
Practice Address - Phone:843-730-3901
Practice Address - Fax:843-730-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier