Healthcare Provider Details

I. General information

NPI: 1740050160
Provider Name (Legal Business Name): CANDY HAIR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 ALBUS HILLS AVE
LAS VEGAS NV
89143-1232
US

IV. Provider business mailing address

7181 N HUALAPAI WAY STE 130-933
LAS VEGAS NV
89166-1115
US

V. Phone/Fax

Practice location:
  • Phone: 702-904-2640
  • Fax: 702-446-6290
Mailing address:
  • Phone: 702-904-2640
  • Fax: 702-446-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: NIKKI A RACHAL
Title or Position: OWNER OPERATOR
Credential: MS
Phone: 702-904-2640