Healthcare Provider Details

I. General information

NPI: 1720994395
Provider Name (Legal Business Name): MANE ILLUSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BUSH RIVER RD STE 5
COLUMBIA SC
29210-5662
US

IV. Provider business mailing address

227 GRANDFLORA LN
COLUMBIA SC
29212-8541
US

V. Phone/Fax

Practice location:
  • Phone: 803-201-4702
  • Fax:
Mailing address:
  • Phone: 803-201-4702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE JOVAN ROBINSON
Title or Position: OWNER
Credential:
Phone: 803-201-4702