Provider Demographics
NPI:1285097048
Name:THE LAUREN FORTE HAIR LOSS REPLACEMENT CENTER
Entity type:Organization
Organization Name:THE LAUREN FORTE HAIR LOSS REPLACEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIR LOSS
Authorized Official - Phone:769-798-1999
Mailing Address - Street 1:143 LAURA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-9787
Mailing Address - Country:US
Mailing Address - Phone:769-798-1999
Mailing Address - Fax:
Practice Address - Street 1:143 LAURA LAKE RD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-9787
Practice Address - Country:US
Practice Address - Phone:769-798-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty