MEDICARE: HAIR SUPPORT SERVICES LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1124951140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAIR SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	4780 N 22ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-6335
Country	:	US
Telephone Number	:	414-628-4780
Fax Number	:

Provider Business Practice Location Address
First Line	:	4780 N 22ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-6335
Country	:	US
Telephone Number	:	414-628-4780
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ISAIAH LAMAR HAIR SR.
Credential	:
Telephone Number	:	414-628-4780

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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