Healthcare Provider Details

I. General information

NPI: 1952247090
Provider Name (Legal Business Name): HOLLYWOOD HOSIERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15801 PROVIDENCE DR APT 12F
SOUTHFIELD MI
48075-3138
US

IV. Provider business mailing address

15801 PROVIDENCE DR APT 12F
SOUTHFIELD MI
48075-3138
US

V. Phone/Fax

Practice location:
  • Phone: 313-917-6769
  • Fax:
Mailing address:
  • Phone: 313-917-6769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA ALLEN
Title or Position: LICENSED COSMETOLOGIST
Credential:
Phone: 313-917-6769