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General NPI Number Information
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NPI Number | 1992473441
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Entity Type | Organization
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Legal Business Name | HEAD QUARTERS CUSTOM HAIR DESIGN LLC
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 948 S HIGHWAY 29
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City | CANTONMENT
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State | FL
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Zip | 32533-6416
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Country | US
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Telephone | 850-816-0122
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Fax |
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Provider Business Mailing Address
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Address Line | 8301 RANGER DR
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City | PENSACOLA
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State | FL
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Zip | 32534-3504
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Country | US
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Telephone | 850-816-0122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ZANDRA MOORE
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Credential |
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Telephone | 850-816-0122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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