Provider Demographics
NPI:1376061051
Name:THE LICE LOUNGE HAIR CARE CENTER
Entity Type:Organization
Organization Name:THE LICE LOUNGE HAIR CARE CENTER
Other - Org Name:THE LICE LOUNGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND COO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:RHEA
Authorized Official - Last Name:MERRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-815-3644
Mailing Address - Street 1:2335 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR TOWNSHIP
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2338
Mailing Address - Country:US
Mailing Address - Phone:651-815-3644
Mailing Address - Fax:
Practice Address - Street 1:2168 3RD ST UNIT 2D
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3233
Practice Address - Country:US
Practice Address - Phone:612-666-0513
Practice Address - Fax:612-666-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local