Healthcare Provider Details

I. General information

NPI: 1871961490
Provider Name (Legal Business Name): MANETAIN HAIR STUDIO AND ACCESSORIES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 BOUNDARY ST B
BEAUFORT SC
29906-3770
US

IV. Provider business mailing address

158 DULAMO RD
SAINT HELENA ISLAND SC
29920-3311
US

V. Phone/Fax

Practice location:
  • Phone: 843-441-4374
  • Fax:
Mailing address:
  • Phone: 843-441-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateSC

VIII. Authorized Official

Name: MRS. TAQUANA L HEYWARD
Title or Position: CERTIFIED HAIR LOSS SPECIALIST
Credential:
Phone: 843-441-4374