Provider Demographics
NPI:1124356373
Name:HANDICAP HOME ACCESS AND MODIFICATIONS
Entity type:Organization
Organization Name:HANDICAP HOME ACCESS AND MODIFICATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:304-650-0828
Mailing Address - Street 1:19 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4586
Mailing Address - Country:US
Mailing Address - Phone:304-233-0929
Mailing Address - Fax:304-233-0920
Practice Address - Street 1:19 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-4586
Practice Address - Country:US
Practice Address - Phone:304-233-0929
Practice Address - Fax:304-233-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV045964332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment