Hidden Secrets Wig & Accessories Boutique West Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

335E00000X Issued in MI

Legal business name

HIDDEN SECRETS WIG & ACCESSORIES BOUTIQUE WEST INC.

Practice address

11539 E Lakewood Blvd
Ste. 120
Holland, MI 49424-7730

Phone

(616) 546-9444

Fax

(616) 546-9443

NPI assigned

Oct 14, 2009

Last updated

Oct 14, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Deborah Kaye Vandenberg

Title

Ceo

Phone

(616) 820-9221

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255478400000",
    "number": "1023343753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11539 E LAKEWOOD BLVD",
            "address_2": "STE. 120",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494247730",
            "telephone_number": "616-546-9444",
            "fax_number": "616-546-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11539 E LAKEWOOD BLVD",
            "address_2": "STE. 120",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494247730",
            "telephone_number": "616-546-9444",
            "fax_number": "616-546-9443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIDDEN SECRETS WIG & ACCESSORIES BOUTIQUE WEST INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-14",
        "last_updated": "2009-10-14",
        "status": "A",
        "authorized_official_last_name": "VANDENBERG",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "KAYE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "616-820-9221",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MI",
            "license": "335E00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Holland, MI
• Providers in Holland, MI by specialty
• Prosthetic/Orthotic Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.