Provider Demographics
NPI:1649090473
Name:ALBANY BEAUTY ACADEMY LLC
Entity type:Organization
Organization Name:ALBANY BEAUTY ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAKENYA
Authorized Official - Middle Name:LACOLE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-938-2083
Mailing Address - Street 1:2231 DAWSON RD STE IJ
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3227
Mailing Address - Country:US
Mailing Address - Phone:229-938-2083
Mailing Address - Fax:888-780-7250
Practice Address - Street 1:2231 DAWSON RD STE IJ
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3227
Practice Address - Country:US
Practice Address - Phone:229-938-2083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty