Provider Demographics
NPI:1871125237
Name:ELITE HAIR REPLACEMENT INC
Entity type:Organization
Organization Name:ELITE HAIR REPLACEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-224-1300
Mailing Address - Street 1:2110 FORT BRAGG RD STE 112
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7036
Mailing Address - Country:US
Mailing Address - Phone:910-224-1300
Mailing Address - Fax:910-816-1306
Practice Address - Street 1:2110 FORT BRAGG RD STE 112
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7036
Practice Address - Country:US
Practice Address - Phone:910-224-1300
Practice Address - Fax:910-816-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier