Provider Demographics
NPI:1992157457
Name:ALL 4 GOD'S GLORY HAIR LOSS CENTER, LLC
Entity type:Organization
Organization Name:ALL 4 GOD'S GLORY HAIR LOSS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / HAIR LOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CERT HAIR LOSS SPEC
Authorized Official - Phone:256-345-9978
Mailing Address - Street 1:916 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2927
Mailing Address - Country:US
Mailing Address - Phone:256-345-9978
Mailing Address - Fax:
Practice Address - Street 1:203 COMMERCE CIR SW
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6856
Practice Address - Country:US
Practice Address - Phone:256-345-9978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty