Organization
A SPECIAL PLACE WIG BOUTIQUE, LLC
Active
Parent organization
A SPECIAL PLACE WIG GALLERY
Other names
A Special Place
Organization subpart
Yes
Provider details
NPI number
Legal business name
A SPECIAL PLACE WIG GALLERY
Authorized official
MRS. JAMELA A HODGSON (OWNER)
(336) 574-0100
Entity
Organization
Contact information
Practice address
5524 WILLIAMSON RD, SUITE 6, ROANOKE, VA 24012-1448
(540) 265-2960
(540) 265-2970
Mailing address
5524 WILLIAMSON RD, SUITE 6, ROANOKE, VA 24012-1448
(540) 265-2960
(540) 265-2970
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
100033237
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629029848
STATE OF NORTH CAROLINA
NC
Enumeration date
04/28/2016
Last updated
04/28/2016
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