Provider Demographics
NPI:1871034892
Name:SOPHISTI CUTS LTD GO GREEN SALON
Entity Type:Organization
Organization Name:SOPHISTI CUTS LTD GO GREEN SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNEY-BIELAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-772-6656
Mailing Address - Street 1:30126 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1648
Mailing Address - Country:US
Mailing Address - Phone:586-772-6656
Mailing Address - Fax:586-772-6674
Practice Address - Street 1:30126 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1648
Practice Address - Country:US
Practice Address - Phone:586-772-6656
Practice Address - Fax:586-772-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies