Provider Demographics
NPI:1437733730
Name:ULTRA BEAUTY AND BRAIDS
Entity Type:Organization
Organization Name:ULTRA BEAUTY AND BRAIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANCILLARY PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATRINNA
Authorized Official - Middle Name:LASHAY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-229-2732
Mailing Address - Street 1:1008 HALL ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3218
Mailing Address - Country:US
Mailing Address - Phone:434-229-2732
Mailing Address - Fax:
Practice Address - Street 1:2245 CAROLINA BEACH RD STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7651
Practice Address - Country:US
Practice Address - Phone:434-229-2732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty