Healthcare Provider Details

I. General information

NPI: 1306244488
Provider Name (Legal Business Name): HAIR'UM IN MOTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3794 VICTORIA RD
WEST PALM BCH FL
33411-6440
US

IV. Provider business mailing address

3794 VICTORIA RD
WEST PALM BCH FL
33411-6440
US

V. Phone/Fax

Practice location:
  • Phone: 561-629-5067
  • Fax:
Mailing address:
  • Phone: 561-629-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number233238
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BLACK
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-629-5067