Provider Demographics
NPI:1447058623
Name:HAIRITAGE HOUSE HAIR SALON
Entity type:Organization
Organization Name:HAIRITAGE HOUSE HAIR SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:HAIR LOSS SPECIALIST
Authorized Official - Phone:346-204-2935
Mailing Address - Street 1:102 FINEGAND PL
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8536
Mailing Address - Country:US
Mailing Address - Phone:478-599-9696
Mailing Address - Fax:
Practice Address - Street 1:4501 RUSSELL PKWY STE 9
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8679
Practice Address - Country:US
Practice Address - Phone:478-599-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty