Provider Demographics
NPI:1326572322
Name:KHR BEAUTY& HAIRLOSS CENTER LLC
Entity Type:Organization
Organization Name:KHR BEAUTY& HAIRLOSS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER-RORIE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIRLOSS
Authorized Official - Phone:919-423-5376
Mailing Address - Street 1:1058 W CLUB BLVD
Mailing Address - Street 2:623
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1104
Mailing Address - Country:US
Mailing Address - Phone:919-423-5376
Mailing Address - Fax:
Practice Address - Street 1:1058 W CLUB BLVD
Practice Address - Street 2:623
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1104
Practice Address - Country:US
Practice Address - Phone:919-423-5376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty