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General NPI Number Information
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NPI Number | 1528294121
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Entity Type | Organization
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Legal Business Name | CHILDREN WITH HAIR LOSS
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 12776 DIXIE HWY
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City | SOUTH ROCKWOOD
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State | MI
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Zip | 48179-1001
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Country | US
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Telephone | 734-379-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 12776 DIXIE HWY
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City | SOUTH ROCKWOOD
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State | MI
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Zip | 48179-1001
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Country | US
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Telephone | 734-379-4400
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | REGINA VILLEMURE
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Credential |
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Telephone | 734-379-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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