Provider Demographics
NPI:1992443071
Name:DIVA HAIR BLESSINGS
Entity type:Organization
Organization Name:DIVA HAIR BLESSINGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-893-7213
Mailing Address - Street 1:608 CEDAR RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-6603
Mailing Address - Country:US
Mailing Address - Phone:301-893-7213
Mailing Address - Fax:
Practice Address - Street 1:608 CEDAR RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-6603
Practice Address - Country:US
Practice Address - Phone:301-893-7213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2725Other2725