Provider Demographics
NPI:1609474535
Name:CUSTOM CE LLC
Entity Type:Organization
Organization Name:CUSTOM CE LLC
Other - Org Name:THE HAIR CENTER CINCINNATI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EDUCATIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIR LOSS
Authorized Official - Phone:513-331-3071
Mailing Address - Street 1:4224 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1826
Mailing Address - Country:US
Mailing Address - Phone:513-331-3071
Mailing Address - Fax:
Practice Address - Street 1:4224 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1826
Practice Address - Country:US
Practice Address - Phone:513-331-3071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUSTOM CE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-13
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty