Provider Demographics
NPI:1467801886
Name:STUDIO ROO, LLC
Entity Type:Organization
Organization Name:STUDIO ROO, LLC
Other - Org Name:BABY MOON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-550-3395
Mailing Address - Street 1:2891 RICHMOND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1720
Mailing Address - Country:US
Mailing Address - Phone:859-550-3395
Mailing Address - Fax:
Practice Address - Street 1:2891 RICHMOND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1720
Practice Address - Country:US
Practice Address - Phone:859-550-3395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty