Provider Demographics
NPI:1417749011
Name:CHAMPAGNE BEAUTY PARLOR LLC
Entity type:Organization
Organization Name:CHAMPAGNE BEAUTY PARLOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANDYS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PROTHESIS SUPPLIER
Authorized Official - Phone:330-524-6602
Mailing Address - Street 1:1741 W MARKET ST # 18
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7001
Mailing Address - Country:US
Mailing Address - Phone:330-524-6602
Mailing Address - Fax:330-524-6602
Practice Address - Street 1:1741 W MARKET ST # 18
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7001
Practice Address - Country:US
Practice Address - Phone:330-524-6602
Practice Address - Fax:330-524-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier