Provider Demographics
NPI:1114569290
Name:THE LAVISH BEAUTY PALACE, LLC
Entity Type:Organization
Organization Name:THE LAVISH BEAUTY PALACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:SHAKESHA
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-528-4247
Mailing Address - Street 1:6701 DEMOCRACY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7500
Mailing Address - Country:US
Mailing Address - Phone:844-528-4247
Mailing Address - Fax:844-528-4247
Practice Address - Street 1:6701 DEMOCRACY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7500
Practice Address - Country:US
Practice Address - Phone:844-528-4247
Practice Address - Fax:844-528-4247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier