Provider Demographics
NPI:1326592080
Name:ROSE PEDALS'
Entity Type:Organization
Organization Name:ROSE PEDALS'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-956-8004
Mailing Address - Street 1:10127 SHANACLEAR AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7906
Mailing Address - Country:US
Mailing Address - Phone:704-956-8004
Mailing Address - Fax:
Practice Address - Street 1:10127 SHANACLEAR AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7906
Practice Address - Country:US
Practice Address - Phone:704-956-8004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38144042347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle