Provider Demographics
NPI:1952153249
Name:ADVANCED HAIR CARE & WELLNESS SPA, LLC
Entity Type:Organization
Organization Name:ADVANCED HAIR CARE & WELLNESS SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-670-0906
Mailing Address - Street 1:14587 FALLING WATERS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1162
Mailing Address - Country:US
Mailing Address - Phone:904-333-0868
Mailing Address - Fax:
Practice Address - Street 1:1021 OAK ST STE 129
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3905
Practice Address - Country:US
Practice Address - Phone:904-670-0906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier