Provider Demographics
NPI:1477989416
Name:THE GOLDEN ROSE WIG SHOPPE
Entity Type:Organization
Organization Name:THE GOLDEN ROSE WIG SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR/LICENSED COSMETOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:GENDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-946-7673
Mailing Address - Street 1:663 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3829
Mailing Address - Country:US
Mailing Address - Phone:401-946-7673
Mailing Address - Fax:401-946-7674
Practice Address - Street 1:663 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3829
Practice Address - Country:US
Practice Address - Phone:401-946-7673
Practice Address - Fax:401-946-7674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHI06907332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies