Provider Demographics
NPI:1164168027
Name:CREATIVE TRESSES LLC
Entity Type:Organization
Organization Name:CREATIVE TRESSES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-456-5048
Mailing Address - Street 1:9700 STONEY GLEN DR APT P
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0476
Mailing Address - Country:US
Mailing Address - Phone:704-456-5048
Mailing Address - Fax:
Practice Address - Street 1:5212 MONROE RD STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7880
Practice Address - Country:US
Practice Address - Phone:980-553-1277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment