Provider Demographics
NPI:1528645819
Name:HAIR DECOR, LLC
Entity type:Organization
Organization Name:HAIR DECOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATESHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CRANIAL PROSTH SPEC
Authorized Official - Phone:713-653-3319
Mailing Address - Street 1:PO BOX 300617
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0617
Mailing Address - Country:US
Mailing Address - Phone:713-653-3319
Mailing Address - Fax:832-583-1020
Practice Address - Street 1:7205 ALMEDA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2191
Practice Address - Country:US
Practice Address - Phone:713-653-3319
Practice Address - Fax:832-583-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier