Provider Demographics
NPI:1285330571
Name:SWIM HAIR LLC
Entity type:Organization
Organization Name:SWIM HAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENADA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-754-8545
Mailing Address - Street 1:8245 E 96TH ST # 1116
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1013
Mailing Address - Country:US
Mailing Address - Phone:317-441-7554
Mailing Address - Fax:
Practice Address - Street 1:1856 SOUTHERNWOOD LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-5210
Practice Address - Country:US
Practice Address - Phone:317-441-7554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier