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General NPI Number Information
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NPI Number | 1740537174
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Entity Type | Organization
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Legal Business Name | MCBRIDE HAIR RESTORATION LLC
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 211 PARK RD LOWER LEVEL
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City | WEST HARTFORD
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State | CT
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Zip | 06119-2014
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Country | US
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Telephone | 860-985-2081
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Fax |
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Provider Business Mailing Address
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Address Line | 211 PARK RD LOWER LEVEL
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City | WEST HARTFORD
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State | CT
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Zip | 06119-2014
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Country | US
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Telephone | 860-985-2081
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DONYELLE MCBRIDE
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Credential |
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Telephone | 960-985-2081
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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 | 046491
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License Number State | CT
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