Provider Demographics
NPI:1366064263
Name:LAVISHINGLUX HAIR IMPORTS
Entity type:Organization
Organization Name:LAVISHINGLUX HAIR IMPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-376-7025
Mailing Address - Street 1:200 BELLE CHASSE CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3164
Mailing Address - Country:US
Mailing Address - Phone:877-376-7025
Mailing Address - Fax:601-348-9887
Practice Address - Street 1:200 BELLE CHASSE CIR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3164
Practice Address - Country:US
Practice Address - Phone:877-376-7025
Practice Address - Fax:601-348-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier