Provider Demographics
NPI:1760883102
Name:MONARCH HAIR SOLUTIONS & SALON, LLC
Entity Type:Organization
Organization Name:MONARCH HAIR SOLUTIONS & SALON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:TRICOLOGIST
Authorized Official - Phone:229-292-9336
Mailing Address - Street 1:404 NORTHSIDE DR STE G
Mailing Address - Street 2:P.O. BOX 745
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1800
Mailing Address - Country:US
Mailing Address - Phone:229-292-9336
Mailing Address - Fax:
Practice Address - Street 1:404 NORTHSIDE DR STE G
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1800
Practice Address - Country:US
Practice Address - Phone:229-292-9336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONARCH HAIR SOLUTIONS & SALON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCOSA050783332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment