Provider Demographics
NPI:1285278762
Name:SISTERS IV A HAIR BOUTIQUE
Entity type:Organization
Organization Name:SISTERS IV A HAIR BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:412-863-8185
Mailing Address - Street 1:47 LACONA ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-3615
Mailing Address - Country:US
Mailing Address - Phone:412-688-9447
Mailing Address - Fax:
Practice Address - Street 1:5510 CENTRE AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1220
Practice Address - Country:US
Practice Address - Phone:412-688-9447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty