Provider Demographics
NPI:1922581651
Name:FACETS OF BEAUTY SALON AND BOUTIQUE, INC.
Entity Type:Organization
Organization Name:FACETS OF BEAUTY SALON AND BOUTIQUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAUSHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-508-6691
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-0013
Mailing Address - Country:US
Mailing Address - Phone:252-508-6691
Mailing Address - Fax:
Practice Address - Street 1:122 HARRISON ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2464
Practice Address - Country:US
Practice Address - Phone:252-508-6691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922581651OtherNPI