Provider Demographics
NPI:1942729041
Name:LAVENDER MOON, LLC
Entity Type:Organization
Organization Name:LAVENDER MOON, LLC
Other - Org Name:LAVENDER MOON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:502-320-7847
Mailing Address - Street 1:1240 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4540
Mailing Address - Country:US
Mailing Address - Phone:502-320-7847
Mailing Address - Fax:
Practice Address - Street 1:130 KINGS DAUGHTERS DR STE 400
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4248
Practice Address - Country:US
Practice Address - Phone:502-219-7488
Practice Address - Fax:502-219-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty