Provider Demographics
NPI:1932894292
Name:HEAVENLY STRANDS CUSTOM CREATIONS
Entity Type:Organization
Organization Name:HEAVENLY STRANDS CUSTOM CREATIONS
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-301-1235
Mailing Address - Street 1:996 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4611
Mailing Address - Country:US
Mailing Address - Phone:757-301-1235
Mailing Address - Fax:
Practice Address - Street 1:996 BAKER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4611
Practice Address - Country:US
Practice Address - Phone:757-301-1265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier