Provider Demographics
NPI:1386426344
Name:IN ALL YOUR GLORY CRANIAL PROSTHETIC LLC
Entity type:Organization
Organization Name:IN ALL YOUR GLORY CRANIAL PROSTHETIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-831-2490
Mailing Address - Street 1:850 TWIN RIVERS DR UNIT 1930
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43216-8065
Mailing Address - Country:US
Mailing Address - Phone:937-831-2490
Mailing Address - Fax:937-831-2490
Practice Address - Street 1:2747 ATWOOD TER
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1107
Practice Address - Country:US
Practice Address - Phone:937-831-2490
Practice Address - Fax:937-831-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies