Provider Demographics
NPI:1003418351
Name:MADELINE HAIR COLLECTION LLC
Entity Type:Organization
Organization Name:MADELINE HAIR COLLECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIBERISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-563-2071
Mailing Address - Street 1:300 SE 2ND ST STE 600
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1950
Mailing Address - Country:US
Mailing Address - Phone:561-563-2071
Mailing Address - Fax:
Practice Address - Street 1:300 SE 2ND ST STE 600
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1950
Practice Address - Country:US
Practice Address - Phone:561-563-2071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment