Provider Demographics
NPI:1639834831
Name:SUGAR ME LACE AND MINK BAR LLC
Entity Type:Organization
Organization Name:SUGAR ME LACE AND MINK BAR LLC
Other - Org Name:FOUNDER/CO-FOUNDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-490-7937
Mailing Address - Street 1:5380 MOSSBERG DR S
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-7322
Mailing Address - Country:US
Mailing Address - Phone:251-490-7937
Mailing Address - Fax:251-666-6434
Practice Address - Street 1:3315 DEMETROPOLIS RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-4641
Practice Address - Country:US
Practice Address - Phone:251-490-7937
Practice Address - Fax:251-666-6434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier