Organization
INDIGO HAIR INNOVATIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEBA SUZANNIE TAYLOR (OWNER)
(631) 433-7506
Entity
Organization
Contact information
Practice address
641 NEW PARK AVE, WEST HARTFORD, CT 06110-1318
(860) 990-1565
Mailing address
641 NEW PARK AVE, WEST HARTFORD, CT 06110-1318
(860) 990-1565
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1744P3200X
—
CT
Enumeration date
08/18/2019
Last updated
08/18/2019
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