Provider Demographics
NPI:1336751122
Name:ROSE BEAUTY BAR
Entity Type:Organization
Organization Name:ROSE BEAUTY BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / STYLIST
Authorized Official - Prefix:
Authorized Official - First Name:MARKEISHA
Authorized Official - Middle Name:IAQUITA
Authorized Official - Last Name:WARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-591-8501
Mailing Address - Street 1:1502 TINY TOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8087
Mailing Address - Country:US
Mailing Address - Phone:931-645-4270
Mailing Address - Fax:
Practice Address - Street 1:1502 TINY TOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-8087
Practice Address - Country:US
Practice Address - Phone:931-645-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty