Provider Demographics
NPI:1407687650
Name:PERFECTED FLAWS LLC
Entity type:Organization
Organization Name:PERFECTED FLAWS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNTENA
Authorized Official - Middle Name:CIANA
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-655-8899
Mailing Address - Street 1:2535 WEDGLEA DR APT 201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2102
Mailing Address - Country:US
Mailing Address - Phone:614-615-3315
Mailing Address - Fax:
Practice Address - Street 1:1268 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2101
Practice Address - Country:US
Practice Address - Phone:614-655-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health