Healthcare Provider Details

I. General information

NPI: 1780102277
Provider Name (Legal Business Name): ONDA'E VIRGIN HAIR LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CAPITAL AVE SW
BATTLE CREEK MI
49015-2627
US

IV. Provider business mailing address

515 CAPITAL AVE SW
BATTLE CREEK MI
49015-2627
US

V. Phone/Fax

Practice location:
  • Phone: 269-753-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ONDEYIA KAYON MORRIS
Title or Position: OWNER
Credential: COSMETOLOGIST
Phone: 517-215-0595