Provider Demographics
NPI:1760245740
Name:BRI LOVE PRODUCTIONS MINI SHOP BY BRI
Entity Type:Organization
Organization Name:BRI LOVE PRODUCTIONS MINI SHOP BY BRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-482-3838
Mailing Address - Street 1:946 W ANDREWS AVE STE Y
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2500
Mailing Address - Country:US
Mailing Address - Phone:919-339-6739
Mailing Address - Fax:
Practice Address - Street 1:946 W ANDREWS AVE STE Y
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2500
Practice Address - Country:US
Practice Address - Phone:919-339-6739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty