Provider Demographics
NPI:1720748668
Name:RENEW YOURSELF HEALTH AND BEAUTY BAR
Entity Type:Organization
Organization Name:RENEW YOURSELF HEALTH AND BEAUTY BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-645-2489
Mailing Address - Street 1:1467 OXPENS RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29851-3295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1467 OXPENS RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29851-3295
Practice Address - Country:US
Practice Address - Phone:803-645-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty