Provider Demographics
NPI:1417401340
Name:NORHE EXTENSIONS SALON MASSAGE
Entity Type:Organization
Organization Name:NORHE EXTENSIONS SALON MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:402-525-7467
Mailing Address - Street 1:111 N 56TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-3583
Mailing Address - Country:US
Mailing Address - Phone:402-525-7467
Mailing Address - Fax:
Practice Address - Street 1:111 N 56TH ST
Practice Address - Street 2:STE 150
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3583
Practice Address - Country:US
Practice Address - Phone:402-525-7467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty