Healthcare Provider Details

I. General information

NPI: 1376365809
Provider Name (Legal Business Name): MAD HAIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 CLEARY AVE STE D
METAIRIE LA
70002-8609
US

IV. Provider business mailing address

1110 PICADILLY CIR
SLIDELL LA
70461-4408
US

V. Phone/Fax

Practice location:
  • Phone: 225-227-6849
  • Fax:
Mailing address:
  • Phone: 225-227-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARTESHA DAVIS
Title or Position: HAIR LOSS SPECIALIST / SALON OWNER
Credential:
Phone: 225-227-6849