Provider Demographics
NPI:1306399340
Name:THE SANCTUARY THE PLACE OF RESTORATION
Entity Type:Organization
Organization Name:THE SANCTUARY THE PLACE OF RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIRLOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ALLINE
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-881-1451
Mailing Address - Street 1:217 W STONE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5434
Mailing Address - Country:US
Mailing Address - Phone:864-881-1451
Mailing Address - Fax:
Practice Address - Street 1:217 W STONE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5434
Practice Address - Country:US
Practice Address - Phone:864-881-1451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology