Provider Demographics
NPI:1609583442
Name:PINK RIBBON BOUTIQUE CHIPPEWA VALLEY LLC
Entity Type:Organization
Organization Name:PINK RIBBON BOUTIQUE CHIPPEWA VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-226-1416
Mailing Address - Street 1:2829 COUNTY HIGHWAY I STE 3
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2678
Mailing Address - Country:US
Mailing Address - Phone:715-492-4068
Mailing Address - Fax:715-723-4451
Practice Address - Street 1:2829 COUNTY HIGHWAY I STE 3
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2678
Practice Address - Country:US
Practice Address - Phone:715-492-4068
Practice Address - Fax:715-723-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNOT ISSUED