Provider Demographics
NPI:1679991103
Name:ALOHA HANDS BODYWORKS LLC
Entity Type:Organization
Organization Name:ALOHA HANDS BODYWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:JURY
Authorized Official - Suffix:
Authorized Official - Credentials:EMP, CLPN, SA
Authorized Official - Phone:440-964-2361
Mailing Address - Street 1:2626 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9721
Mailing Address - Country:US
Mailing Address - Phone:440-964-2361
Mailing Address - Fax:440-964-0130
Practice Address - Street 1:615 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3262
Practice Address - Country:US
Practice Address - Phone:440-964-2361
Practice Address - Fax:440-964-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty