Provider Demographics
NPI:1376235150
Name:BIOHAX WELLNESS AND AESTHETICS, LLC
Entity Type:Organization
Organization Name:BIOHAX WELLNESS AND AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-707-1377
Mailing Address - Street 1:108 N WHITE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2020
Mailing Address - Country:US
Mailing Address - Phone:773-707-1377
Mailing Address - Fax:
Practice Address - Street 1:108 N WHITE ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2020
Practice Address - Country:US
Practice Address - Phone:773-707-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOHAX WELLNESS AND AESTHETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No332H00000XSuppliersEyewear Supplier
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)