Provider Demographics
NPI:1548904816
Name:THE LAND OF HER
Entity type:Organization
Organization Name:THE LAND OF HER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROSTHETICS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TANEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:ACCESS MANAGER
Authorized Official - Phone:773-370-3726
Mailing Address - Street 1:2829 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1135
Mailing Address - Country:US
Mailing Address - Phone:773-349-3464
Mailing Address - Fax:773-352-9492
Practice Address - Street 1:2829 W 87TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1135
Practice Address - Country:US
Practice Address - Phone:873-349-3464
Practice Address - Fax:773-352-9492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-23
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier