Provider Demographics
NPI:1184418113
Name:EMINERE HAIR LLC
Entity type:Organization
Organization Name:EMINERE HAIR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROSTHESES
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:CRANIAL PROSTHESES
Authorized Official - Phone:312-523-8270
Mailing Address - Street 1:2618 N HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2302
Mailing Address - Country:US
Mailing Address - Phone:312-523-8270
Mailing Address - Fax:312-523-8270
Practice Address - Street 1:2618 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2302
Practice Address - Country:US
Practice Address - Phone:312-523-8270
Practice Address - Fax:312-523-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies