Healthcare Provider Details

I. General information

NPI: 1891646071
Provider Name (Legal Business Name): PRECISION SCALP HAIR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 EARLE BROWN DR STE 104
BROOKLYN CENTER MN
55430-2523
US

IV. Provider business mailing address

6040 EARLE BROWN DR STE 104
BROOKLYN CENTER MN
55430-2523
US

V. Phone/Fax

Practice location:
  • Phone: 612-461-4703
  • Fax:
Mailing address:
  • Phone: 612-461-9724
  • Fax: 612-416-1646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: SHAVON RUSH
Title or Position: OWNER
Credential:
Phone: 612-461-9724