Provider Demographics
NPI:1851957872
Name:MANE MEDIC HAIR REJUVENATION LLC
Entity Type:Organization
Organization Name:MANE MEDIC HAIR REJUVENATION LLC
Other - Org Name:MANE MEDIC HAIR REJUVENATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROSTHETIC ORTHOTIC SUPPLIER
Authorized Official - Prefix:
Authorized Official - First Name:TIMIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-690-5617
Mailing Address - Street 1:2120 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3514
Mailing Address - Country:US
Mailing Address - Phone:419-407-5595
Mailing Address - Fax:
Practice Address - Street 1:2120 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-3514
Practice Address - Country:US
Practice Address - Phone:419-407-5595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty