Healthcare Provider Details

I. General information

NPI: 1942605035
Provider Name (Legal Business Name): AGAPE HAIR GROWTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27800 WEST SEVEN MILE RD 200
LIVONIA MI
48152
US

IV. Provider business mailing address

301 WILCREST DR APT 3901
HOUSTON TX
77042-1096
US

V. Phone/Fax

Practice location:
  • Phone: 847-220-7817
  • Fax:
Mailing address:
  • Phone: 248-739-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number2701184017
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number2701184017
License Number StateMI

VIII. Authorized Official

Name: AGAPE NIOLE JORDAN
Title or Position: TRICHOLOGIST/PRIV,N
Credential: MA, TR,CO
Phone: 248-739-1275