Provider Demographics
NPI:1790479640
Name:YOUNGER SALON INC.
Entity Type:Organization
Organization Name:YOUNGER SALON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS EXPERT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:YOUNGER
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-230-6302
Mailing Address - Street 1:1803 HYDEN PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4435
Mailing Address - Country:US
Mailing Address - Phone:571-230-6302
Mailing Address - Fax:
Practice Address - Street 1:6133 BACKLICK RD STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2637
Practice Address - Country:US
Practice Address - Phone:571-230-6302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier