Provider Demographics
NPI:1548447311
Name:SOFT TOUCH BOUTIQUE, LTD
Entity type:Organization
Organization Name:SOFT TOUCH BOUTIQUE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:COBB
Authorized Official - Last Name:GLAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:TF
Authorized Official - Phone:804-520-0484
Mailing Address - Street 1:2200 BOULEVARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2305
Mailing Address - Country:US
Mailing Address - Phone:804-520-0484
Mailing Address - Fax:804-520-0729
Practice Address - Street 1:2200 BOULEVARD
Practice Address - Street 2:SUITE B
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2305
Practice Address - Country:US
Practice Address - Phone:804-520-0484
Practice Address - Fax:804-520-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA039332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0738290001Medicare NSC