Provider Demographics
NPI:1770291528
Name:BOUGIE BRAT HAIR LLC
Entity type:Organization
Organization Name:BOUGIE BRAT HAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-726-0922
Mailing Address - Street 1:18034 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3067
Mailing Address - Country:US
Mailing Address - Phone:225-726-0922
Mailing Address - Fax:
Practice Address - Street 1:9151 INTERLINE AVE STE 12B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1970
Practice Address - Country:US
Practice Address - Phone:225-726-8034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier