Provider Demographics
NPI:1285366781
Name:CROWN BEAUTY TRESSES RX
Entity type:Organization
Organization Name:CROWN BEAUTY TRESSES RX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-274-6684
Mailing Address - Street 1:480 GEORGE WALLACE DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-2280
Mailing Address - Country:US
Mailing Address - Phone:910-260-3147
Mailing Address - Fax:
Practice Address - Street 1:480 GEORGE WALLACE DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-2280
Practice Address - Country:US
Practice Address - Phone:910-260-3147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROWN BEAUTY SUPPLY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-24
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier