Provider Demographics
NPI:1992578025
Name:B&G BEAUTY COMPANY LLC
Entity type:Organization
Organization Name:B&G BEAUTY COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTWILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-946-4602
Mailing Address - Street 1:2907 KEEPSAKE WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3945
Mailing Address - Country:US
Mailing Address - Phone:303-946-4602
Mailing Address - Fax:
Practice Address - Street 1:3234 S. WADSWORTH BLVD.
Practice Address - Street 2:UNIT A
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-8022
Practice Address - Country:US
Practice Address - Phone:303-955-4882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty