Provider Demographics
NPI:1902582174
Name:EXTREME BEAUTY MEDICAL HAIR LOSS & MEDICAL WIG INC
Entity Type:Organization
Organization Name:EXTREME BEAUTY MEDICAL HAIR LOSS & MEDICAL WIG INC
Other - Org Name:EXTREME BEAUTY MEDICAL HAIR LOSS & MEDICAL WIG INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FALESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-327-8708
Mailing Address - Street 1:23 W MARKET ST UNIT 41
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-1254
Mailing Address - Country:US
Mailing Address - Phone:717-327-8708
Mailing Address - Fax:
Practice Address - Street 1:910 S GEORGE ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3708
Practice Address - Country:US
Practice Address - Phone:717-327-8708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier