Provider Demographics
NPI:1295986065
Name:MIRAGE HAIR SYSTEMS, INC.
Entity type:Organization
Organization Name:MIRAGE HAIR SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATER
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:STRASHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:COS-BA
Authorized Official - Phone:541-484-2790
Mailing Address - Street 1:SUITE 210 OAKWAY CENTER
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-484-2790
Mailing Address - Fax:541-484-2790
Practice Address - Street 1:SUITE 210 OAKWAY CTR
Practice Address - Street 2:SUITE 210
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5618
Practice Address - Country:US
Practice Address - Phone:541-484-2790
Practice Address - Fax:541-484-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCOS-BA-10119120335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier