Provider Demographics
NPI:1972856987
Name:HAILE VILLAGE SPA & SALON
Entity Type:Organization
Organization Name:HAILE VILLAGE SPA & SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPA DIRECTOR/SPA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-335-5025
Mailing Address - Street 1:5207 SW 91ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7125
Mailing Address - Country:US
Mailing Address - Phone:352-335-5025
Mailing Address - Fax:352-335-2445
Practice Address - Street 1:5207 SW 91ST TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7125
Practice Address - Country:US
Practice Address - Phone:352-335-5025
Practice Address - Fax:352-335-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM 29063261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service