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General NPI Number Information
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NPI Number | 1871125237
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Entity Type | Organization
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Legal Business Name | ELITE HAIR REPLACEMENT INC
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 2110 FORT BRAGG RD STE 112
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-7036
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Country | US
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Telephone | 910-224-1300
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Fax | 910-816-1306
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Provider Business Mailing Address
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Address Line | 2110 FORT BRAGG RD STE 112
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-7036
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Country | US
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Telephone | 910-224-1300
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Fax | 910-816-1306
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Authorized Official
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Title or Position | CEO
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Name | DOMINIC HILL
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Credential |
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Telephone | 910-224-1300
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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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