Provider Demographics
NPI:1760876833
Name:HEALTHY HAIR SOLUTIONS HAIR LOSS CENTER LLC
Entity Type:Organization
Organization Name:HEALTHY HAIR SOLUTIONS HAIR LOSS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:863-688-3704
Mailing Address - Street 1:1549 LAKELAND HILLS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3207
Mailing Address - Country:US
Mailing Address - Phone:863-699-3704
Mailing Address - Fax:
Practice Address - Street 1:1549 LAKELAND HILLS BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3207
Practice Address - Country:US
Practice Address - Phone:863-699-3704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCE998900111744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty