Healthcare Provider Details

I. General information

NPI: 1427563600
Provider Name (Legal Business Name): BEAUTY EMPIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2017
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 HAYES ST NE
WASHINGTON DC
20019-1722
US

IV. Provider business mailing address

3742 HAYES ST NE
WASHINGTON DC
20019-1722
US

V. Phone/Fax

Practice location:
  • Phone: 202-629-8572
  • Fax:
Mailing address:
  • Phone: 202-629-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCOM2738
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberCOM2738
License Number StateDC

VIII. Authorized Official

Name: MRS. DELORES FRY
Title or Position: BILLING SPECIALIST
Credential:
Phone: 817-361-4342