Provider Demographics
NPI:1043816077
Name:HAIR BY KOLA LLC
Entity Type:Organization
Organization Name:HAIR BY KOLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENNEGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-349-4231
Mailing Address - Street 1:1260 SWEETGRASS ST
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 FLOWERS ST STE A
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7832
Practice Address - Country:US
Practice Address - Phone:919-349-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier