Provider Demographics
NPI:1922352962
Name:TEXTURES HAIR STUDIO, LLC
Entity Type:Organization
Organization Name:TEXTURES HAIR STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:VONETTA
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-917-4732
Mailing Address - Street 1:8301 ASHFORD BLVD
Mailing Address - Street 2:1105
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5601
Mailing Address - Country:US
Mailing Address - Phone:301-917-4732
Mailing Address - Fax:
Practice Address - Street 1:925 FAIRLAWN AVE
Practice Address - Street 2:101A
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4805
Practice Address - Country:US
Practice Address - Phone:301-917-4732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier