MEDICARE: BLACK ESSENCE BEAUTY SUPPLY

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	:	1760260368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK ESSENCE BEAUTY SUPPLY

Provider Business Mailing Address
First Line	:	8359 FROST AVE
Second Line	:
City	:	BERKELEY
State	:	MO
Zip	:	63134-1448
Country	:	US
Telephone Number	:	314-372-9683
Fax Number	:

Provider Business Practice Location Address
First Line	:	8359 FROST AVE
Second Line	:
City	:	BERKELEY
State	:	MO
Zip	:	63134-1448
Country	:	US
Telephone Number	:	314-372-9683
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIELLE CARTER
Credential	:	ED.D
Telephone Number	:	314-372-9683

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	09/18/2023

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Directions to “BLACK ESSENCE BEAUTY SUPPLY ” Practice Location

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