MEDICARE: PLUSH HAIR EXTENSIONS RX.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1043076532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUSH HAIR EXTENSIONS RX.

Provider Business Mailing Address
First Line	:	6014 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-3205
Country	:	US
Telephone Number	:	440-565-7577
Fax Number	:

Provider Business Practice Location Address
First Line	:	6014 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-3205
Country	:	US
Telephone Number	:	440-565-7577
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSLYN CHAMBERS
Credential	:
Telephone Number	:	216-253-6015

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	02/22/2024

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