Provider Demographics
NPI:1780388744
Name:GLAMRUSH BEAUTY BAR LLC
Entity type:Organization
Organization Name:GLAMRUSH BEAUTY BAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT
Authorized Official - Prefix:
Authorized Official - First Name:ZUMURRUDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-260-9551
Mailing Address - Street 1:128 NE LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2216
Mailing Address - Country:US
Mailing Address - Phone:253-260-9551
Mailing Address - Fax:
Practice Address - Street 1:2225 LLOYD CTR FL 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1315
Practice Address - Country:US
Practice Address - Phone:503-837-7368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty