Provider Demographics
NPI:1245823392
Name:THE MANE MASTERPIECE LLC
Entity type:Organization
Organization Name:THE MANE MASTERPIECE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-916-9909
Mailing Address - Street 1:5357 WYNDTREE LN SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-0837
Mailing Address - Country:US
Mailing Address - Phone:616-916-9909
Mailing Address - Fax:
Practice Address - Street 1:5357 WYNDTREE LN SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-0837
Practice Address - Country:US
Practice Address - Phone:616-916-9909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment