Provider Demographics
NPI:1740537174
Name:MCBRIDE HAIR RESTORATION LLC
Entity type:Organization
Organization Name:MCBRIDE HAIR RESTORATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONYELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:960-985-2081
Mailing Address - Street 1:211 PARK RD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2014
Mailing Address - Country:US
Mailing Address - Phone:860-985-2081
Mailing Address - Fax:
Practice Address - Street 1:211 PARK RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2014
Practice Address - Country:US
Practice Address - Phone:860-985-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046491332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies