Randall Kenneth Cantrell, GENERAL CONTRACTOR
Individual provider Active NPI Home Modifications Contractor · Pound, VA
NPI 1689712010 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1689712010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Modifications Contractor 171WH0202X
- License
- 2705030223 (VA)
- Practice address
- 8902 Orby Cantrell Hwy
Pound, VA 24279-3216 - Phone
- (276) 796-5789
- Fax
- (276) 796-5789
- NPI assigned
- Feb 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2705030223 | VA | MD | Home Modifications Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 2705030223 | VA | Yes |
Addresses
Primary practice location
8902 Orby Cantrell Hwy
Pound, VA 24279-3216
Mailing address
8902 Orby Cantrell Hwy
Pound, VA 24279-3216
Phone (276) 796-5789
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010277388 | Medicaid | VA |
Other providers in Pound, VA
- Zachary Ryan Bush
- Caring Hearts of VA Inc
- Caring Touch Home Health, Inc.
- Michael Brian Deel
- Experienced Care Clinic Inc.
- Family Preservation Services, Inc
All providers in Pound, VA · Home Modifications Contractor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.