Provider Demographics
NPI:1760260368
Name:BLACK ESSENCE BEAUTY SUPPLY
Entity Type:Organization
Organization Name:BLACK ESSENCE BEAUTY SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:314-372-9683
Mailing Address - Street 1:8359 FROST AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:MO
Mailing Address - Zip Code:63134-1448
Mailing Address - Country:US
Mailing Address - Phone:314-372-9683
Mailing Address - Fax:
Practice Address - Street 1:8359 FROST AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:MO
Practice Address - Zip Code:63134-1448
Practice Address - Country:US
Practice Address - Phone:314-372-9683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACK ESSENCE BEAUTY SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-15
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier