Healthcare Provider Details

I. General information

NPI: 1598383366
Provider Name (Legal Business Name): SUPERIOR IMAGE HAIR STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PUSEY AVE
COLLINGDALE PA
19023-1909
US

IV. Provider business mailing address

716 MACDADE BLVD
COLLINGDALE PA
19023-3825
US

V. Phone/Fax

Practice location:
  • Phone: 610-710-6665
  • Fax:
Mailing address:
  • Phone: 610-200-4952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: EVELYN JOYNER
Title or Position: OWNER
Credential:
Phone: 610-200-4952