Provider Demographics
NPI:1568214450
Name:H2O HAIR REHAB AND BEAUTY LAB LLC
Entity Type:Organization
Organization Name:H2O HAIR REHAB AND BEAUTY LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:RC/HLS
Authorized Official - Phone:803-851-3353
Mailing Address - Street 1:494 MARSH POINTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7025
Mailing Address - Country:US
Mailing Address - Phone:803-851-3353
Mailing Address - Fax:509-757-4562
Practice Address - Street 1:208 EASCOTT PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-5500
Practice Address - Country:US
Practice Address - Phone:803-851-3353
Practice Address - Fax:509-757-4562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1942848643Medicaid