Provider Demographics
NPI:1164043444
Name:HAIR SEW GORGEOUS
Entity Type:Organization
Organization Name:HAIR SEW GORGEOUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-998-2202
Mailing Address - Street 1:104 E OVILLA RD UNIT 35
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-9203
Mailing Address - Country:US
Mailing Address - Phone:972-998-2202
Mailing Address - Fax:214-833-5627
Practice Address - Street 1:2021 N HAMPTON RD STE 160
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8625
Practice Address - Country:US
Practice Address - Phone:972-998-2202
Practice Address - Fax:214-833-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier