Provider Demographics
NPI:1154945418
Name:DREAM HAIR CARE
Entity type:Organization
Organization Name:DREAM HAIR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARNISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-618-5467
Mailing Address - Street 1:4401 W 4TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1006
Mailing Address - Country:US
Mailing Address - Phone:601-618-5467
Mailing Address - Fax:208-400-5298
Practice Address - Street 1:4401 W 4TH ST STE E
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1006
Practice Address - Country:US
Practice Address - Phone:601-618-5467
Practice Address - Fax:208-400-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier