Provider Demographics
NPI:1336390350
Name:CROCKETT HOME IMPROVEMENT INC
Entity Type:Organization
Organization Name:CROCKETT HOME IMPROVEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:G
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-382-8747
Mailing Address - Street 1:1255 RADFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2845
Mailing Address - Country:US
Mailing Address - Phone:540-382-8747
Mailing Address - Fax:540-381-4316
Practice Address - Street 1:1255 RADFORD ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2845
Practice Address - Country:US
Practice Address - Phone:540-382-8747
Practice Address - Fax:540-381-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705035703A332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment