Provider Demographics
NPI:1134874241
Name:DE'BORAH VIRTUOUS HANDS HAIR CLINIC LLC
Entity type:Organization
Organization Name:DE'BORAH VIRTUOUS HANDS HAIR CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR STYLIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-914-4197
Mailing Address - Street 1:10390 SCARLETT SKIMMER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-6277
Mailing Address - Country:US
Mailing Address - Phone:919-914-4197
Mailing Address - Fax:
Practice Address - Street 1:11909 E DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4934
Practice Address - Country:US
Practice Address - Phone:919-914-4197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & SuppliesGroup - Single Specialty