Provider Demographics
NPI:1295961589
Name:RENEW SALON & DAY SPA LLC
Entity type:Organization
Organization Name:RENEW SALON & DAY SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOMECIA
Authorized Official - Middle Name:UVONNE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-225-9697
Mailing Address - Street 1:2154 N CENTER ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4080
Mailing Address - Country:US
Mailing Address - Phone:843-225-9697
Mailing Address - Fax:
Practice Address - Street 1:2154 N CENTER ST STE 203B
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4080
Practice Address - Country:US
Practice Address - Phone:843-225-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30604171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty