Provider Demographics
NPI:1851851273
Name:BAM BEAUTY AND MASSAGE LLC
Entity Type:Organization
Organization Name:BAM BEAUTY AND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSCOYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-241-7928
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:WILLAMINA
Mailing Address - State:OR
Mailing Address - Zip Code:97396-0329
Mailing Address - Country:US
Mailing Address - Phone:971-241-7928
Mailing Address - Fax:971-275-1314
Practice Address - Street 1:242 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLAMINA
Practice Address - State:OR
Practice Address - Zip Code:97396-2784
Practice Address - Country:US
Practice Address - Phone:971-241-7928
Practice Address - Fax:971-275-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty