Provider Demographics
NPI:1164830964
Name:AMELIA SALON LLC
Entity Type:Organization
Organization Name:AMELIA SALON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HLS
Authorized Official - Phone:334-262-3972
Mailing Address - Street 1:1023 WOODLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2429
Mailing Address - Country:US
Mailing Address - Phone:334-262-3972
Mailing Address - Fax:
Practice Address - Street 1:1023 WOODLEY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2429
Practice Address - Country:US
Practice Address - Phone:334-262-3972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier