Provider Demographics
NPI:1417082728
Name:HAIR RESPONSE
Entity Type:Organization
Organization Name:HAIR RESPONSE
Other - Org Name:HAIR RESPONSE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED BREAST PRO
Authorized Official - Phone:920-437-0707
Mailing Address - Street 1:2301 RIVERSIDE DR
Mailing Address - Street 2:HAIR RESPONSE
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-619-3662
Mailing Address - Fax:
Practice Address - Street 1:2301 RIVERSIDE DR
Practice Address - Street 2:HAIR RESPONSE
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-619-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0654930001Medicare NSC