Provider Demographics
NPI:1407514532
Name:AZALEA HEALTH & SKIN TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:AZALEA HEALTH & SKIN TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASEDOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-467-2360
Mailing Address - Street 1:1000 ASHLAND DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7097
Mailing Address - Country:US
Mailing Address - Phone:606-467-2360
Mailing Address - Fax:606-467-2359
Practice Address - Street 1:1000 ASHLAND DR STE 303
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7097
Practice Address - Country:US
Practice Address - Phone:606-467-2360
Practice Address - Fax:606-467-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center