Healthcare Provider Details

I. General information

NPI: 1235022195
Provider Name (Legal Business Name): MAKEOVERS HAIR REPLACEMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W FRONT ST
BURLINGTON NC
27215-3729
US

IV. Provider business mailing address

206 W FRONT ST
BURLINGTON NC
27215-3729
US

V. Phone/Fax

Practice location:
  • Phone: 336-675-6494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TOMEKA STEPHENS
Title or Position: OWNER
Credential:
Phone: 336-675-6494