Provider Demographics
NPI:1528294121
Name:CHILDREN WITH HAIR LOSS
Entity type:Organization
Organization Name:CHILDREN WITH HAIR LOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLEMURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-379-4400
Mailing Address - Street 1:12776 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48179-1001
Mailing Address - Country:US
Mailing Address - Phone:734-379-4400
Mailing Address - Fax:
Practice Address - Street 1:12776 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:SOUTH ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48179-1001
Practice Address - Country:US
Practice Address - Phone:734-379-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
41571OtherCFC