Provider Demographics
NPI:1164148318
Name:TOTAL TRANSFORMATION HAIR REPLACEMENT CENTER
Entity Type:Organization
Organization Name:TOTAL TRANSFORMATION HAIR REPLACEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RASBERRY-DIMANCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-673-8297
Mailing Address - Street 1:13137 UPLAND MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-2058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6646 IRON HORSE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6037
Practice Address - Country:US
Practice Address - Phone:870-329-3919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies