Provider Demographics
NPI:1144720871
Name:PLENTIFUL HAIR STUDIO LLC
Entity type:Organization
Organization Name:PLENTIFUL HAIR STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MYEESHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIR LOSS
Authorized Official - Phone:708-502-3099
Mailing Address - Street 1:324 166TH ST
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-6217
Mailing Address - Country:US
Mailing Address - Phone:708-502-3099
Mailing Address - Fax:
Practice Address - Street 1:3224 RIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3191
Practice Address - Country:US
Practice Address - Phone:708-529-6000
Practice Address - Fax:708-538-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL011.2798871744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty