Provider Demographics
NPI:1346862042
Name:EXQUISITE BEAUTY HAIR REPLACEMENT CENTER
Entity Type:Organization
Organization Name:EXQUISITE BEAUTY HAIR REPLACEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:HAIR LOSS PRACTITION
Authorized Official - Phone:757-567-2698
Mailing Address - Street 1:109G GAINSBOROUGH SQ # 162
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1707
Mailing Address - Country:US
Mailing Address - Phone:757-567-2698
Mailing Address - Fax:
Practice Address - Street 1:1580 CROSSWAYS BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0206
Practice Address - Country:US
Practice Address - Phone:757-567-2698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXQUISITE BEAUTY INDUSTRIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-15
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty