Provider Demographics
NPI:1881224228
Name:TAILORED MADE HAIR REPLACEMENT CENTER LLC
Entity Type:Organization
Organization Name:TAILORED MADE HAIR REPLACEMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-818-8554
Mailing Address - Street 1:2521 LAORIS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2224
Mailing Address - Country:US
Mailing Address - Phone:573-818-8554
Mailing Address - Fax:
Practice Address - Street 1:201 W SWITZLER ST STE B
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240-1594
Practice Address - Country:US
Practice Address - Phone:573-818-8554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty