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General NPI Number Information
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NPI Number | 1891699195
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Entity Type | Organization
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Legal Business Name | EBONY LUXE HAIR, LLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 1510 BROADWAY ST
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City | BLUE ISLAND
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State | IL
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Zip | 60406-2708
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Country | US
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Telephone | 773-603-2276
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 BROADWAY ST
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City | BLUE ISLAND
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State | IL
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Zip | 60406-2708
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Country | US
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Telephone | 773-603-2276
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Fax |
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Authorized Official
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Title or Position | OWNER / MANAGING MEMBER
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Name | EBONY R PHILLIPS
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Credential |
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Telephone | 773-603-2276
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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 | NULL
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