Provider Demographics
NPI:1962180927
Name:STAGE 1 HAIR LOSS REPLACEMENT & SALON LLC
Entity type:Organization
Organization Name:STAGE 1 HAIR LOSS REPLACEMENT & SALON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:ALANDA
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-773-0241
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653-0240
Mailing Address - Country:US
Mailing Address - Phone:601-384-4532
Mailing Address - Fax:601-384-4532
Practice Address - Street 1:216 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653
Practice Address - Country:US
Practice Address - Phone:601-384-4532
Practice Address - Fax:601-384-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty