Provider Demographics
NPI:1497385454
Name:PHENOMENAL HAIR REPLACEMENT SERVICES LLC
Entity Type:Organization
Organization Name:PHENOMENAL HAIR REPLACEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NON SURGICAL HAIR REPLACEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:SPECIALIST
Authorized Official - Phone:803-477-5243
Mailing Address - Street 1:9400 TWO NOTCH RD STE E1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5946
Mailing Address - Country:US
Mailing Address - Phone:803-477-5243
Mailing Address - Fax:803-753-4353
Practice Address - Street 1:9400 TWO NOTCH RD STE E1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5946
Practice Address - Country:US
Practice Address - Phone:803-477-5243
Practice Address - Fax:803-753-4353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANOINTED CUTS BARBER & BEAUTY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies