Provider Demographics
NPI:1619429685
Name:REVAMPED BEAUTY
Entity Type:Organization
Organization Name:REVAMPED BEAUTY
Other - Org Name:REVAMPED BEAUTY HAIR LOSS SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS-GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-478-7518
Mailing Address - Street 1:1024 KERRY DR
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-5512
Mailing Address - Country:US
Mailing Address - Phone:205-478-7518
Mailing Address - Fax:
Practice Address - Street 1:2714 ENSLEY 5 POINTS W AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-2853
Practice Address - Country:US
Practice Address - Phone:205-478-7518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No251V00000XAgenciesVoluntary or Charitable
No335E00000XSuppliersProsthetic/Orthotic Supplier