Provider Demographics
NPI:1407447261
Name:RESTORED CROWN HAIR RESTORATION CLINIC LLC
Entity Type:Organization
Organization Name:RESTORED CROWN HAIR RESTORATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAKARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:TRICHOLOGIST
Authorized Official - Phone:443-686-2487
Mailing Address - Street 1:3766 US HIGHWAY 17 STE 102
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-8872
Mailing Address - Country:US
Mailing Address - Phone:912-312-7272
Mailing Address - Fax:
Practice Address - Street 1:3766 US HIGHWAY 17 STE 102
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8872
Practice Address - Country:US
Practice Address - Phone:912-312-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center