Provider Demographics
NPI:1174938393
Name:COURTLAND HEARING AIDS AND BALANCE, LLC
Entity type:Organization
Organization Name:COURTLAND HEARING AIDS AND BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-653-7658
Mailing Address - Street 1:26089 GUY PLACE RD
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23837-2745
Mailing Address - Country:US
Mailing Address - Phone:757-653-7658
Mailing Address - Fax:
Practice Address - Street 1:22730 MAIN ST
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:VA
Practice Address - Zip Code:23837-1127
Practice Address - Country:US
Practice Address - Phone:757-653-7532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001409261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356383558Medicaid