Provider Demographics
NPI:1942605035
Name:AGAPE HAIR GROWTH CLINIC
Entity Type:Organization
Organization Name:AGAPE HAIR GROWTH CLINIC
Other - Org Name:HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRICHOLOGIST/PRIV,N
Authorized Official - Prefix:
Authorized Official - First Name:AGAPE NIOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, TR,CO
Authorized Official - Phone:248-739-1275
Mailing Address - Street 1:301 WILCREST DR APT 3901
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1096
Mailing Address - Country:US
Mailing Address - Phone:248-739-1275
Mailing Address - Fax:
Practice Address - Street 1:27800 WEST SEVEN MILE RD
Practice Address - Street 2:200
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:847-220-7817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI27011840171744R1102X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty