Provider Demographics
NPI:1588471379
Name:FANCY HAIR, LLC
Entity type:Organization
Organization Name:FANCY HAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBIASAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-580-6541
Mailing Address - Street 1:3304 WEEPING WILLOW CT APT 42
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2531
Mailing Address - Country:US
Mailing Address - Phone:301-580-6541
Mailing Address - Fax:
Practice Address - Street 1:3704 E WEST HWY STE 121
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2355
Practice Address - Country:US
Practice Address - Phone:301-580-6541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier