=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528747060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL U DESIRE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2023
-----------------------------------------------------
Last Update Date | 07/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 LINEBERGER ST
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28150-4543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-300-6159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 WHEATFIELD DR
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28152-8413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-300-6159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LATONYIA BYRD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-300-6159
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------