Provider Demographics
NPI:1871059931
Name:CROCKETT REMODELING INC DBA BATHPLANET OF LYNCHBURG
Entity type:Organization
Organization Name:CROCKETT REMODELING INC DBA BATHPLANET OF LYNCHBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:DILNWILDDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-384-9500
Mailing Address - Street 1:6011 DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:HUDDLESTON
Mailing Address - State:VA
Mailing Address - Zip Code:24104-3572
Mailing Address - Country:US
Mailing Address - Phone:434-384-9500
Mailing Address - Fax:
Practice Address - Street 1:6011 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:HUDDLESTON
Practice Address - State:VA
Practice Address - Zip Code:24104-3572
Practice Address - Country:US
Practice Address - Phone:434-384-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health