# DIVINE BEAUTY BAR, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902399942
- **Authorized official:** DEZAREE' LUSK HAIR LOSS SPECIALIST (OWNER)
- **Authorized official phone:** (469) 499-6200

## Contact information

- **Practice address:** 4201 CYPRESS CREEK PKWY STE 322, HOUSTON, TX 77068-3414
- **Practice address phone:** (469) 499-6200
- **Practice address fax:** (469) 519-5839
- **Mailing address:** 4201 CYPRESS CREEK PKWY STE 322, HOUSTON, TX 77068-3414
- **Mailing address phone:** (469) 499-6200
- **Mailing address fax:** (469) 519-5839

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1744P3200X | Prosthetics Case Management | 1449535 | TX | — |
| 251E00000X | Home Health Agency | — | NULL | — |
| 251G00000X | Community Based Hospice Care Agency | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 06/13/2018
- **Last updated:** 04/30/2025