MEDICARE: CHILDREN WITH HAIR LOSS

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41571	OTHER		CFC

General Provider Information

NPI Number	:	1528294121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN WITH HAIR LOSS

Provider Business Mailing Address
First Line	:	12776 DIXIE HWY
Second Line	:
City	:	SOUTH ROCKWOOD
State	:	MI
Zip	:	48179-1001
Country	:	US
Telephone Number	:	734-379-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	12776 DIXIE HWY
Second Line	:
City	:	SOUTH ROCKWOOD
State	:	MI
Zip	:	48179-1001
Country	:	US
Telephone Number	:	734-379-4400
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	REGINA VILLEMURE
Credential	:
Telephone Number	:	734-379-4400

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	04/30/2014

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Directions to “CHILDREN WITH HAIR LOSS ” Practice Location

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