Healthcare Provider Details

I. General information

NPI: 1427662626
Provider Name (Legal Business Name): HAIR REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 HOLLAND ST
ANGUILLA MS
38721-3872
US

IV. Provider business mailing address

PO BOX 242
ANGUILLA MS
38721-0242
US

V. Phone/Fax

Practice location:
  • Phone: 662-744-2675
  • Fax:
Mailing address:
  • Phone: 662-744-2675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELIA COLEMAN
Title or Position: HAIR LOSS SPECIALIST
Credential:
Phone: 662-744-2675