Provider Demographics
NPI:1457957797
Name:DIVERSITY ALTERNATIVE HAIR SOLUTION
Entity type:Organization
Organization Name:DIVERSITY ALTERNATIVE HAIR SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-543-3385
Mailing Address - Street 1:1200 MELBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4137
Mailing Address - Country:US
Mailing Address - Phone:216-543-3385
Mailing Address - Fax:
Practice Address - Street 1:1200 MELBOURNE RD
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4137
Practice Address - Country:US
Practice Address - Phone:216-543-3385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty