Provider Demographics
NPI:1801646708
Name:HAIRDR. RESTORATION STUDIOS LLC
Entity type:Organization
Organization Name:HAIRDR. RESTORATION STUDIOS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:GRACELYN
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-564-3399
Mailing Address - Street 1:4209 GLEN ABBEY DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-8530
Mailing Address - Country:US
Mailing Address - Phone:682-564-3399
Mailing Address - Fax:
Practice Address - Street 1:5260 S HULEN ST # 24
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1912
Practice Address - Country:US
Practice Address - Phone:817-517-8496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies