Provider Demographics
NPI:1992473441
Name:HEAD QUARTERS CUSTOM HAIR DESIGN LLC
Entity type:Organization
Organization Name:HEAD QUARTERS CUSTOM HAIR DESIGN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-816-0122
Mailing Address - Street 1:8301 RANGER DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-3504
Mailing Address - Country:US
Mailing Address - Phone:850-816-0122
Mailing Address - Fax:
Practice Address - Street 1:948 S HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-6416
Practice Address - Country:US
Practice Address - Phone:850-816-0122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies