Healthcare Provider Details

I. General information

NPI: 1942927942
Provider Name (Legal Business Name): LUXXE HAIR COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 PENDRAGON BLVD APT A
INDIANAPOLIS IN
46268-2432
US

IV. Provider business mailing address

1389 W. 86TH ST. PMB# 224
INDIANAPOLIS IN
46260
US

V. Phone/Fax

Practice location:
  • Phone: 317-721-7490
  • Fax:
Mailing address:
  • Phone: 317-721-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: MS. TANIA FOWLER
Title or Position: CEO
Credential:
Phone: 317-721-7490