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General NPI Number Information
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NPI Number | 1538857115
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Entity Type | Organization
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Legal Business Name | KEAVA'S HAIR CASTLE LLC
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 3303 AIRLINE BLVD STE 3F
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2635
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Country | US
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Telephone | 804-365-2102
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Fax |
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Provider Business Mailing Address
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Address Line | 3303 AIRLINE BLVD STE 3F
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2635
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Country | US
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Telephone | 804-365-2102
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Fax |
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Authorized Official
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Title or Position | MEDICAL WIG PROVIDER
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Name | CARRIE B RAWLS
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Credential |
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Telephone | 804-365-2102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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