1932812401 NPI number — IRIS LUXURY HAIR, LLC

Table of content: (NPI 1932812401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932812401 NPI number — IRIS LUXURY HAIR, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRIS LUXURY HAIR, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932812401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 LAKE KATHRYN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERRETT
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35147-8068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-913-7622
Provider Business Mailing Address Fax Number:
888-502-4077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5511 HIGHWAY 280 STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-438-6406
Provider Business Practice Location Address Fax Number:
888-502-4077
Provider Enumeration Date:
12/29/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
IRIS
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
205-913-7622

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)