Provider Demographics
NPI:1356121560
Name:ADVANCE HAIR CARE CLINIC ,LLC
Entity type:Organization
Organization Name:ADVANCE HAIR CARE CLINIC ,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-683-0519
Mailing Address - Street 1:2404A NORTHUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1525
Mailing Address - Country:US
Mailing Address - Phone:804-424-3304
Mailing Address - Fax:804-424-3305
Practice Address - Street 1:2404A NORTHUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1525
Practice Address - Country:US
Practice Address - Phone:804-424-3304
Practice Address - Fax:804-424-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment