Provider Demographics
NPI:1508451998
Name:VIRTUOUS STYLEZ HAIR LOSS SPECIALIST, LLC
Entity Type:Organization
Organization Name:VIRTUOUS STYLEZ HAIR LOSS SPECIALIST, LLC
Other - Org Name:VIRTUOUS STYLEZ WIG AND HAIR BAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HAIR LOSS SPECIALIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-514-2868
Mailing Address - Street 1:4302 E 62ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4568
Mailing Address - Country:US
Mailing Address - Phone:317-514-2868
Mailing Address - Fax:
Practice Address - Street 1:4302 E 62ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4568
Practice Address - Country:US
Practice Address - Phone:317-514-2868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies