MEDICARE: EARTHLY BEAUTY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1528879319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARTHLY BEAUTY LLC

Provider Business Mailing Address
First Line	:	7457 PATTERSON RD STE 111
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-0710
Country	:	US
Telephone Number	:	803-719-2077
Fax Number	:

Provider Business Practice Location Address
First Line	:	7457 PATTERSON RD STE 111
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-0710
Country	:	US
Telephone Number	:	803-719-2077
Fax Number	:

Authorized Official
Title or Position	:	CEP
Name	:	NAKIA SCORE
Credential	:
Telephone Number	:	803-719-2077

Provider Enumeration Date	:	01/20/2025
Last Update Date	:	04/14/2026

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Directions to “EARTHLY BEAUTY LLC ” Practice Location

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