Provider Demographics
NPI:1639879745
Name:SALON HAIR FORTE
Entity Type:Organization
Organization Name:SALON HAIR FORTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COXUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-464-0355
Mailing Address - Street 1:604 TILGHMAN DR APT 5B
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5528
Mailing Address - Country:US
Mailing Address - Phone:919-464-0355
Mailing Address - Fax:
Practice Address - Street 1:1411 W CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4503
Practice Address - Country:US
Practice Address - Phone:919-464-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA