Healthcare Provider Details

I. General information

NPI: 1114512423
Provider Name (Legal Business Name): HEALINGS HANDS HAIR RESTORATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 ACADEMY ST STE B
COLUMBIA SC
29203-6958
US

IV. Provider business mailing address

1904 ACADEMY ST STE B
COLUMBIA SC
29203-6958
US

V. Phone/Fax

Practice location:
  • Phone: 803-708-2212
  • Fax:
Mailing address:
  • Phone: 803-708-2212
  • 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 Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GWENDOLYN L DAVIS
Title or Position: PRESIDENT
Credential: CERTIFIED HAIR LOSS
Phone: 803-708-2212