Provider Demographics
NPI:1710430905
Name:STANDING OVATION SERVICE & SUPPLY LLC
Entity Type:Organization
Organization Name:STANDING OVATION SERVICE & SUPPLY LLC
Other - Org Name:OWENS HAIR & SCALP RESTORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:SR
Authorized Official - Credentials:HLPC
Authorized Official - Phone:912-388-8030
Mailing Address - Street 1:288 N LANIER ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-1351
Mailing Address - Country:US
Mailing Address - Phone:912-658-7019
Mailing Address - Fax:
Practice Address - Street 1:288 N LANIER ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-1351
Practice Address - Country:US
Practice Address - Phone:912-658-7019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty