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General NPI Number Information
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NPI Number | 1902399942
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Entity Type | Organization
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Legal Business Name | DIVINE BEAUTY BAR, LLC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 4201 CYPRESS CREEK PKWY STE 322
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City | HOUSTON
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State | TX
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Zip | 77068-3414
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Country | US
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Telephone | 469-499-6200
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Fax | 469-519-5839
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Provider Business Mailing Address
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Address Line | 4201 CYPRESS CREEK PKWY STE 322
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City | HOUSTON
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State | TX
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Zip | 77068-3414
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Country | US
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Telephone | 469-499-6200
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Fax | 469-519-5839
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Authorized Official
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Title or Position | OWNER
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Name | DEZAREE' LUSK
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Credential | HAIR LOSS SPECIALIST
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Telephone | 469-499-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 1449535
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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