Provider Demographics
NPI:1326896648
Name:MISHAWNNA INDUSTRIES LLC
Entity type:Organization
Organization Name:MISHAWNNA INDUSTRIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-460-2792
Mailing Address - Street 1:3200 DEBIDUE LN
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1791
Mailing Address - Country:US
Mailing Address - Phone:803-460-2792
Mailing Address - Fax:803-574-3033
Practice Address - Street 1:3200 DEBIDUE LN
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1791
Practice Address - Country:US
Practice Address - Phone:803-460-2792
Practice Address - Fax:803-574-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management