Provider Demographics
NPI:1164155594
Name:ESSENCE OF BEAUTY AND HEALTH
Entity Type:Organization
Organization Name:ESSENCE OF BEAUTY AND HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKOW
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:610-850-4713
Mailing Address - Street 1:PO BOX 1196
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-1196
Mailing Address - Country:US
Mailing Address - Phone:610-850-4713
Mailing Address - Fax:
Practice Address - Street 1:3169 BRAVERTON ST
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2679
Practice Address - Country:US
Practice Address - Phone:610-850-4713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810027068Medicaid