Healthcare Provider Details

I. General information

NPI: 1194067751
Provider Name (Legal Business Name): PROFESSIONAL HAIR INSTITUTE OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 E HAMPDEN AVE SUITE 102
DENVER CO
80224-3016
US

IV. Provider business mailing address

6740 E HAMPDEN AVE SUITE 102
DENVER CO
80224-3016
US

V. Phone/Fax

Practice location:
  • Phone: 303-782-4858
  • Fax: 303-782-4877
Mailing address:
  • Phone: 303-782-4858
  • Fax: 303-782-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number266892
License Number StateCO

VIII. Authorized Official

Name: MR. HAROLD D MITCHELL
Title or Position: PRES
Credential:
Phone: 303-782-4858