MEDICARE: ALL INCLUSIVE CROWND BEAUTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1346003886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL INCLUSIVE CROWND BEAUTY

Provider Business Mailing Address
First Line	:	14321 CLIMBING ROSE WAY APT 201
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20121-5189
Country	:	US
Telephone Number	:	571-359-0178
Fax Number	:	703-977-9415

Provider Business Practice Location Address
First Line	:	10980 BULLOCH DR # 12
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20109-2226
Country	:	US
Telephone Number	:	202-870-0302
Fax Number	:	703-977-9415

Authorized Official
Title or Position	:	OWNER
Name	:	RITA JEAN BRIGGS
Credential	:
Telephone Number	:	202-870-0302

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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