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General NPI Number Information
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NPI Number | 1225960453
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Entity Type | Organization
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Legal Business Name | LAVEA LACE CUSTOM WIGS AND HAIRPIECES LLC
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 1382 MACKINAW AVE
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City | CALUMET CITY
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State | IL
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Zip | 60409-5928
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Country | US
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Telephone | 708-916-5093
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Fax |
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Provider Business Mailing Address
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Address Line | 18141 DIXIE HWY STE 202
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City | HOMEWOOD
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State | IL
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Zip | 60430-2243
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Country | US
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Telephone | 708-916-5093
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HAKEEM GAYDEN
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Credential |
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Telephone | 708-916-5093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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