Lovely Layed Wig Shop LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

LOVELY LAYED WIG SHOP LLC

Practice address

4007 167TH St
Country Club Hills, IL 60478-2022

Phone

(708) 551-5579

NPI assigned

Aug 19, 2022

Organization subpart

No

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

Authorized official

Name

Dericka Cooper

Title

Owner

Phone

(773) 603-8535

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1660867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660867200000",
    "number": "1790403350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7565 S HOYNE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606205736",
            "telephone_number": "773-603-8535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4007 167TH ST",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604782022",
            "telephone_number": "708-551-5579"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7916 S Western Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606205911",
            "country_code": "US",
            "telephone_number": "773-424-4122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LOVELY LAYED WIG SHOP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-19",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "DERICKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-603-8535"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "7736038535",
            "affiliation": "N",
            "endpointDescription": "Fax",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "7916 S Western Ave Ste 2",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606205911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Country Club Hills, IL
• Providers in Country Club Hills, IL by specialty
• Prosthetic/Orthotic Supplier in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; 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.