Provider Demographics
NPI:1760870224
Name:AMANDAS MINI DAY SPA
Entity Type:Organization
Organization Name:AMANDAS MINI DAY SPA
Other - Org Name:AMANDAS MINI DAY SPA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:314-467-0766
Mailing Address - Street 1:510 E CHAIN OF ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-2803
Mailing Address - Country:US
Mailing Address - Phone:314-467-0766
Mailing Address - Fax:
Practice Address - Street 1:510 E CHAIN OF ROCKS RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-2803
Practice Address - Country:US
Practice Address - Phone:314-467-0766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010642314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility