Provider Demographics
NPI:1609502285
Name:KANDASCE HAIR PROFESSIONALS INC
Entity Type:Organization
Organization Name:KANDASCE HAIR PROFESSIONALS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS PERTEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-407-0154
Mailing Address - Street 1:17513 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17513 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2007
Practice Address - Country:US
Practice Address - Phone:708-407-0154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAIR SAUCE BEAUTY LOUNGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier