Provider Demographics
NPI:1891022018
Name:THE HAIR KINGDOM INC
Entity Type:Organization
Organization Name:THE HAIR KINGDOM INC
Other - Org Name:THE HAIR KINGDOM INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:EMMA
Authorized Official - Last Name:DORSEY ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:COSEMTOLIGIST
Authorized Official - Phone:617-427-5911
Mailing Address - Street 1:51 HUMBOLDT AVE
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1643
Mailing Address - Country:US
Mailing Address - Phone:617-427-5911
Mailing Address - Fax:617-427-7762
Practice Address - Street 1:51 HUMBOLDT AVE
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1643
Practice Address - Country:US
Practice Address - Phone:617-427-5911
Practice Address - Fax:617-427-7762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106052305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service