Provider Demographics
NPI:1114227998
Name:COMPLETE IMAGE OF HAIR DESIGNS INC.
Entity Type:Organization
Organization Name:COMPLETE IMAGE OF HAIR DESIGNS INC.
Other - Org Name:COMPLETE IMAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-461-4247
Mailing Address - Street 1:6555 WILSON MILLS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3435
Mailing Address - Country:US
Mailing Address - Phone:440-461-4247
Mailing Address - Fax:
Practice Address - Street 1:6555 WILSON MILLS ROAD STE 105
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLIAGE
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-461-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHDS. 061085171W00000X
332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier