Provider Demographics
NPI: | 1265861405 |
---|---|
Name: | MANE EVENT SALON LLC |
Entity Type: | Organization |
Organization Name: | MANE EVENT SALON LLC |
Other - Org Name: | MANE EVENT SALON LLC |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | CERTIFIED HAIR LOSS SPECIALIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EUGENIA |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CERTIFIEDHAIRLOSSSPE |
Authorized Official - Phone: | 423-468-3425 |
Mailing Address - Street 1: | 5525 SAINT ELMO AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CHATTANOOGA |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37409-2312 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 423-468-3425 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5525 SAINT ELMO AVE |
Practice Address - Street 2: | |
Practice Address - City: | CHATTANOOGA |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37409-2312 |
Practice Address - Country: | US |
Practice Address - Phone: | 423-468-3425 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-11-07 |
Last Update Date: | 2013-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1744P3200X | Other Service Providers | Specialist | Prosthetics Case Management | Group - Single Specialty |