Provider Demographics
NPI:1194208611
Name:J'NICOLE MANAGEMENT COMPANY LLC.
Entity Type:Organization
Organization Name:J'NICOLE MANAGEMENT COMPANY LLC.
Other - Org Name:HELLO BEAUTIFUL MASTECTOMY BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-353-1123
Mailing Address - Street 1:4701 WESTWOOD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8272
Mailing Address - Country:US
Mailing Address - Phone:501-353-1123
Mailing Address - Fax:
Practice Address - Street 1:4701 WESTWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-8272
Practice Address - Country:US
Practice Address - Phone:501-353-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment