Provider Demographics
NPI:1992396196
Name:TULIPS HAIR BOUTIQUE, LLC
Entity Type:Organization
Organization Name:TULIPS HAIR BOUTIQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOVELETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-713-5726
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-0390
Mailing Address - Country:US
Mailing Address - Phone:443-713-5726
Mailing Address - Fax:
Practice Address - Street 1:10706 REISTERSTOWN RD UNIT G
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2720
Practice Address - Country:US
Practice Address - Phone:443-713-5726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-30
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment