Provider Demographics
NPI:1447967443
Name:E.M. EXOTIC HAIR CREATION & SUPPLY INC
Entity type:Organization
Organization Name:E.M. EXOTIC HAIR CREATION & SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-888-9695
Mailing Address - Street 1:10300 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3120
Mailing Address - Country:US
Mailing Address - Phone:561-200-2820
Mailing Address - Fax:
Practice Address - Street 1:10300 FOREST HILL BLVD STE 270
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3130
Practice Address - Country:US
Practice Address - Phone:561-200-2820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier