Provider Demographics
NPI:1124228333
Name:GAYLE MARIES FASHIONS FOR WOMEN
Entity Type:Organization
Organization Name:GAYLE MARIES FASHIONS FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-527-1381
Mailing Address - Street 1:649 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-3343
Mailing Address - Country:US
Mailing Address - Phone:530-527-1381
Mailing Address - Fax:530-527-1381
Practice Address - Street 1:649 MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3343
Practice Address - Country:US
Practice Address - Phone:530-527-1381
Practice Address - Fax:530-527-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99136553332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0803750001Medicare NSC