Provider Demographics
NPI:1992971113
Name:HAIR WITH CARE BOUTIQUE, LLC
Entity type:Organization
Organization Name:HAIR WITH CARE BOUTIQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:DICKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-641-9587
Mailing Address - Street 1:1198 ARBORVISTA DRIVE, NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-641-9587
Mailing Address - Fax:404-800-6329
Practice Address - Street 1:1198 ARBORVISTA DRIVE, NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-641-9587
Practice Address - Fax:404-800-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies