Provider Demographics
NPI:1689413718
Name:CROWN ME WIGS LLC
Entity type:Organization
Organization Name:CROWN ME WIGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-377-9201
Mailing Address - Street 1:2828 N CENTRAL AVE # 1021
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1021
Mailing Address - Country:US
Mailing Address - Phone:202-377-9201
Mailing Address - Fax:
Practice Address - Street 1:115 W 6TH ST STE 113
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-3814
Practice Address - Country:US
Practice Address - Phone:202-377-9201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROWN ME WIGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier