Provider Demographics
NPI:1891569919
Name:GENTLE STIX COLLECTION, TRAINING & MOBILE LLC
Entity Type:Organization
Organization Name:GENTLE STIX COLLECTION, TRAINING & MOBILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMMONS-EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-200-1557
Mailing Address - Street 1:3555 CAMDEN HWY
Mailing Address - Street 2:STE 1
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040
Mailing Address - Country:US
Mailing Address - Phone:803-200-1557
Mailing Address - Fax:803-607-9276
Practice Address - Street 1:3555 CAMDEN HWY
Practice Address - Street 2:STE 1
Practice Address - City:DALZELL
Practice Address - State:SC
Practice Address - Zip Code:29040
Practice Address - Country:US
Practice Address - Phone:803-200-1557
Practice Address - Fax:803-607-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center