Provider Demographics
NPI:1982141115
Name:DEBRAS HAIR STUDIO LLC
Entity Type:Organization
Organization Name:DEBRAS HAIR STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:MOTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-993-4545
Mailing Address - Street 1:1516 BYPASS 72 NE STE D
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-2268
Mailing Address - Country:US
Mailing Address - Phone:864-993-4545
Mailing Address - Fax:
Practice Address - Street 1:1516 BYPASS 72 NE STE D
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-993-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier