Healthcare Provider Details

I. General information

NPI: 1366064263
Provider Name (Legal Business Name): LAVISHINGLUX HAIR IMPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BELLE CHASSE CIR
JACKSON MS
39212-3164
US

IV. Provider business mailing address

200 BELLE CHASSE CIR
JACKSON MS
39212-3164
US

V. Phone/Fax

Practice location:
  • Phone: 877-376-7025
  • Fax: 601-348-9887
Mailing address:
  • Phone: 877-376-7025
  • Fax: 601-348-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KIARA KINCAID
Title or Position: OWNER
Credential:
Phone: 877-376-7025