Provider Demographics
NPI:1922788041
Name:PRETTY MOMENTS BOUTIQUE CARE LLC
Entity Type:Organization
Organization Name:PRETTY MOMENTS BOUTIQUE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LASHAUNDA
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-223-1295
Mailing Address - Street 1:517 S COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4501
Mailing Address - Country:US
Mailing Address - Phone:513-223-1295
Mailing Address - Fax:
Practice Address - Street 1:10979 REED HARTMAN HWY STE 227
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2882
Practice Address - Country:US
Practice Address - Phone:513-223-1295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty