Provider Demographics
NPI:1033772868
Name:PLUSH ROSE A BLOWOUT BAR SALON INC.
Entity type:Organization
Organization Name:PLUSH ROSE A BLOWOUT BAR SALON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SHERELL
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-898-9454
Mailing Address - Street 1:2534 WYNNTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2180
Mailing Address - Country:US
Mailing Address - Phone:706-317-2115
Mailing Address - Fax:
Practice Address - Street 1:2534 WYNNTON RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2180
Practice Address - Country:US
Practice Address - Phone:706-317-2115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty