Provider Demographics
NPI:1508289547
Name:SHUGABABIES
Entity Type:Organization
Organization Name:SHUGABABIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAWANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTUES-BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-694-4772
Mailing Address - Street 1:24690 PEBBLE BEACH LN
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5545
Mailing Address - Country:US
Mailing Address - Phone:313-694-4772
Mailing Address - Fax:
Practice Address - Street 1:24690 PEBBLE BEACH LN
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-5545
Practice Address - Country:US
Practice Address - Phone:313-694-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies