Provider Demographics
NPI:1306615422
Name:DIVINE BEAUTY SUPPLY INC
Entity type:Organization
Organization Name:DIVINE BEAUTY SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-773-3600
Mailing Address - Street 1:810 POLK ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2414
Mailing Address - Country:US
Mailing Address - Phone:318-657-0416
Mailing Address - Fax:
Practice Address - Street 1:2715 MACKEY PL STE 130
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2528
Practice Address - Country:US
Practice Address - Phone:318-657-0416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier