Provider Demographics
NPI:1619319282
Name:ZEN HEALTH WELLNESS AND BEAUTY CLINIC
Entity Type:Organization
Organization Name:ZEN HEALTH WELLNESS AND BEAUTY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SELISA
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:BHAVSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-252-9890
Mailing Address - Street 1:3875 ROBERT C. BYRD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3875
Mailing Address - Country:US
Mailing Address - Phone:304-252-9890
Mailing Address - Fax:304-252-9901
Practice Address - Street 1:3875 ROBERT C. BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3875
Practice Address - Country:US
Practice Address - Phone:304-252-9890
Practice Address - Fax:304-252-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11044261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVB08302Medicare UPIN