Provider Demographics
NPI:1336682251
Name:FAB FASHION LLC
Entity Type:Organization
Organization Name:FAB FASHION LLC
Other - Org Name:LIFE QUALITY MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MCWHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-580-6215
Mailing Address - Street 1:8519 E MARIPOSA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1828
Mailing Address - Country:US
Mailing Address - Phone:480-586-7540
Mailing Address - Fax:
Practice Address - Street 1:8519 E MARIPOSA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1828
Practice Address - Country:US
Practice Address - Phone:480-586-7540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21026027332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies