Provider Demographics
NPI:1407451362
Name:HAIR EMPIRE BEAUTY SUPPLY
Entity Type:Organization
Organization Name:HAIR EMPIRE BEAUTY SUPPLY
Other - Org Name:EMPIRE MEDICAL WIGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU-ANSAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:331-250-3527
Mailing Address - Street 1:1236 W BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6568
Mailing Address - Country:US
Mailing Address - Phone:630-394-1992
Mailing Address - Fax:
Practice Address - Street 1:1236 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-6568
Practice Address - Country:US
Practice Address - Phone:630-394-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies