Healthcare Provider Details

I. General information

NPI: 1922581651
Provider Name (Legal Business Name): FACETS OF BEAUTY SALON AND BOUTIQUE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 05/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 HARRISON ST
WILLIAMSTON NC
27892-2464
US

IV. Provider business mailing address

PO BOX 13
WILLIAMSTON NC
27892-0013
US

V. Phone/Fax

Practice location:
  • Phone: 252-508-6691
  • Fax:
Mailing address:
  • Phone: 252-508-6691
  • 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: TAUSHIMA MOORE
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 252-508-6691