Healthcare Provider Details

I. General information

NPI: 1245926179
Provider Name (Legal Business Name): PINK DIAMOND BEAUTY MALL DETROIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17350 LIVERNOIS AVE
DETROIT MI
48221-2759
US

IV. Provider business mailing address

17350 LIVERNOIS AVE
DETROIT MI
48221-2759
US

V. Phone/Fax

Practice location:
  • Phone: 855-683-7465
  • Fax:
Mailing address:
  • Phone: 313-768-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: KATRINA BELIN
Title or Position: OWNER
Credential:
Phone: 855-683-7465