Provider Demographics
NPI:1932958568
Name:HAIR VANITY LLC
Entity type:Organization
Organization Name:HAIR VANITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS SPT.
Authorized Official - Prefix:
Authorized Official - First Name:CORLETHIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-632-2105
Mailing Address - Street 1:26441 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4528
Mailing Address - Country:US
Mailing Address - Phone:248-632-2105
Mailing Address - Fax:
Practice Address - Street 1:26441 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4528
Practice Address - Country:US
Practice Address - Phone:248-632-2105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty