=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205269750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL ABOUT YOU HAIR SALON INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2013
-----------------------------------------------------
Last Update Date | 03/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3469 S DUPONT HWY
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19934-1371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-698-5299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3469 S DUPONT HWY
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19934-1371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-698-5299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. PEGGY BAILEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-698-5299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BN1400X
-----------------------------------------------------
Taxonomy Name | Nursing Facility Supplies (DME)
-----------------------------------------------------
License Number | 2002110162
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 2002110162
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------