Provider Demographics
NPI:1003409442
Name:LISA FERESTAD SALON, LLC
Entity Type:Organization
Organization Name:LISA FERESTAD SALON, LLC
Other - Org Name:CURA HAIR SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FERESTAD
Authorized Official - Suffix:
Authorized Official - Credentials:HAIR LOSS SPECIALIST
Authorized Official - Phone:678-643-2373
Mailing Address - Street 1:750 DANIELL DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1104
Mailing Address - Country:US
Mailing Address - Phone:678-643-2373
Mailing Address - Fax:
Practice Address - Street 1:531 ROSELANE ST NW STE 630
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6973
Practice Address - Country:US
Practice Address - Phone:678-643-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier