Provider Demographics
NPI:1972263523
Name:EXQUISITE COIFFURES HAIR BOUTIQUE LLC
Entity Type:Organization
Organization Name:EXQUISITE COIFFURES HAIR BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-531-2123
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36089-0211
Mailing Address - Country:US
Mailing Address - Phone:334-247-7727
Mailing Address - Fax:
Practice Address - Street 1:234 PRAIRIE ST N
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-1617
Practice Address - Country:US
Practice Address - Phone:334-247-7727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment