Provider Demographics
NPI:1790368041
Name:BOSS BABE WIG CLEANERS
Entity Type:Organization
Organization Name:BOSS BABE WIG CLEANERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-367-5524
Mailing Address - Street 1:4818 GATEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3407
Mailing Address - Country:US
Mailing Address - Phone:972-367-5524
Mailing Address - Fax:
Practice Address - Street 1:4818 GATEWOOD RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3407
Practice Address - Country:US
Practice Address - Phone:972-367-5524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier