# FAIRYTALE HAIR L.L.C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fairytale Hair L.L.C
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851857189
- **Authorized official:** BREANNA RICHARDSON (OWNER)
- **Authorized official phone:** (501) 650-3405

## Contact information

- **Practice address:** 1802 S HIGHWAY 161, JACKSONVILLE, AR 72076-5511
- **Practice address phone:** (501) 605-3405
- **Mailing address:** 192 WILLIAMSBURG CV, CABOT, AR 72023-9433
- **Mailing address phone:** (501) 650-3405

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1744P3200X | Prosthetics Case Management | — | NULL | Yes |
| 1744P3200X | Prosthetics Case Management | — | — | Yes |

## Other

- **Enumeration date:** 02/12/2019
- **Last updated:** 02/12/2019