Organization
XTEND MY HAIR SALON & CO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRENCE RANDELL MITCHELL HAIR LOSS SPECIALIST (CERTIFIED HAIR LOSS SPECIALIST)
(501) 732-6041
Entity
Organization
Contact information
Practice address
1004 DYER ST, MALVERN, AR 72104-5255
(501) 732-6041
Mailing address
327 WOODLAND ST, MALVERN, AR 72104-3334
(150) 173-2604
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
09/28/2020
Last updated
04/25/2022
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