Indigo Hair Innovations LLC

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

Legal business name

INDIGO HAIR INNOVATIONS LLC

Practice address

641 New Park Ave
West Hartford, CT 06110-1318

Phone

(860) 990-1565

NPI assigned

Aug 18, 2019

Organization subpart

No

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

Authorized official

Name

Tasheba Suzannie Taylor

Title

Owner

Phone

(631) 433-7506

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1566086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566086400000",
    "number": "1184270894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "641 NEW PARK AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061101318",
            "telephone_number": "860-990-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "641 NEW PARK AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061101318",
            "telephone_number": "860-990-1565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39 Market Sq",
            "address_purpose": "LOCATION",
            "city": "Newington",
            "state": "CT",
            "postal_code": "061112929",
            "country_code": "US",
            "telephone_number": "860-990-1565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDIGO HAIR INNOVATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-18",
        "last_updated": "2019-08-18",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "TASHEBA",
        "authorized_official_middle_name": "SUZANNIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-433-7506"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist, Prosthetics Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1744P3200X",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Prosthetics Case Management in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Prosthetics Case Management in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2019; 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.