=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699371633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BARB LIFE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2020
-----------------------------------------------------
Last Update Date | 12/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 N OLD ORCHARD LN APT 921
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-3433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-941-3066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 194 CIVIC CIR UNIT 292395
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75029-0022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-941-3066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KENDRA BLACHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-941-3066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------