Provider Demographics
NPI:1336911718
Name:DESTANI TRICHOLOGY SERVICE LLC
Entity Type:Organization
Organization Name:DESTANI TRICHOLOGY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-956-7555
Mailing Address - Street 1:177 FREEPORT RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3426
Mailing Address - Country:US
Mailing Address - Phone:888-341-2389
Mailing Address - Fax:
Practice Address - Street 1:177 FREEPORT RD STE 2
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3426
Practice Address - Country:US
Practice Address - Phone:888-341-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty