Provider Demographics
NPI:1336907443
Name:THE GOOD WIFE LINGERIE LLC
Entity Type:Organization
Organization Name:THE GOOD WIFE LINGERIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:615-440-3264
Mailing Address - Street 1:107 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2835
Mailing Address - Country:US
Mailing Address - Phone:615-440-3264
Mailing Address - Fax:
Practice Address - Street 1:107 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2835
Practice Address - Country:US
Practice Address - Phone:615-440-3264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GOOD WIFE LINGERIE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies