Healthcare Provider Details

I. General information

NPI: 1063252161
Provider Name (Legal Business Name): RACHELS HAIR LOFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9130 MAYTIDE ST
WALDORF MD
20603-7013
US

IV. Provider business mailing address

9130 MAYTIDE ST
WALDORF MD
20603-7013
US

V. Phone/Fax

Practice location:
  • Phone: 609-529-8185
  • Fax:
Mailing address:
  • Phone: 609-529-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: RACHEL ELISE BROOKS
Title or Position: CEO
Credential:
Phone: 609-529-8185