Provider Demographics
NPI:1851046601
Name:BEST MEDSPA LLC
Entity Type:Organization
Organization Name:BEST MEDSPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAWAKALIT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAO
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, NP-C
Authorized Official - Phone:773-216-3223
Mailing Address - Street 1:426 KEVIN WAY
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1182
Mailing Address - Country:US
Mailing Address - Phone:773-216-3223
Mailing Address - Fax:
Practice Address - Street 1:426 KEVIN WAY
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-1182
Practice Address - Country:US
Practice Address - Phone:773-216-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1356096929OtherPOINT OF CARE
IL1780272294OtherNPPES
IL1003404518OtherNURSING SERVICES