Provider Demographics
NPI:1780398453
Name:POWER CUTZ BARBER SHOP LLC
Entity type:Organization
Organization Name:POWER CUTZ BARBER SHOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:DE'SANTIS
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:JR
Authorized Official - Credentials:SPECIALIST
Authorized Official - Phone:803-504-4067
Mailing Address - Street 1:1256 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5538
Mailing Address - Country:US
Mailing Address - Phone:843-945-4546
Mailing Address - Fax:
Practice Address - Street 1:1256 3RD AVE S
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5538
Practice Address - Country:US
Practice Address - Phone:843-945-4546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies