Provider Demographics
NPI:1104594928
Name:THE HAIR RESUSCITATION PLACE
Entity type:Organization
Organization Name:THE HAIR RESUSCITATION PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JAKINNA
Authorized Official - Middle Name:SHIPARRI
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:HLPC, MHCS
Authorized Official - Phone:864-497-9823
Mailing Address - Street 1:130 SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3861
Mailing Address - Country:US
Mailing Address - Phone:864-497-9823
Mailing Address - Fax:
Practice Address - Street 1:130 SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3861
Practice Address - Country:US
Practice Address - Phone:864-497-9823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies