Provider Demographics
NPI:1134879026
Name:ADA LEROUX HAIR, LLC
Entity type:Organization
Organization Name:ADA LEROUX HAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEROUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-787-6848
Mailing Address - Street 1:1755 N BROWN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:678-787-6848
Mailing Address - Fax:678-820-7965
Practice Address - Street 1:1755 N BROWN RD
Practice Address - Street 2:STE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043
Practice Address - Country:US
Practice Address - Phone:678-787-6848
Practice Address - Fax:678-820-7965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment