MEDICARE: SALON 180 ANGELS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QC0050X	Critical Access Hospital Clinic/Center
2	174200000X	Meals Provider
3	315D00000X	Inpatient Hospice
4	261Q00000X	Clinic/Center
5	251V00000X	Voluntary or Charitable Agency
6	261QF0400X	Federally Qualified Health Center (FQHC)
7	251C00000X	Developmentally Disabled Services Day Training Agency
8	261QP2300X	Primary Care Clinic/Center
9	282E00000X	Long Term Care Hospital
10	251B00000X	Case Management Agency
11	261QH0100X	Health Service Clinic/Center
12	251S00000X	Community/Behavioral Health Agency
13	251J00000X	Nursing Care Agency
14	261QP3300X	Pain Clinic/Center
15	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194380345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALON 180 ANGELS INC

Provider Business Mailing Address
First Line	:	2580 CYPRESS CREEK PKWY STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 CYPRESS CREEK PKWY STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3706
Country	:	US
Telephone Number	:	281-881-9660
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARLANA VICKERS
Credential	:
Telephone Number	:	281-881-9660

Provider Enumeration Date	:	05/03/2019
Last Update Date	:	01/06/2026

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