Healthcare Provider Details

I. General information

NPI: 1427590900
Provider Name (Legal Business Name): REJUVENATION MASSAGE BY FRANCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 CHACE AVENUE
GREENWOOD SC
29646
US

IV. Provider business mailing address

610 CHACE AVE
GREENWOOD SC
29646-4463
US

V. Phone/Fax

Practice location:
  • Phone: 864-407-1973
  • Fax:
Mailing address:
  • Phone: 864-407-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9897
License Number StateSC

VIII. Authorized Official

Name: MS. FRANCES MARIE ADAMS
Title or Position: MASSAGE THERAPIST
Credential: LICENSE 9897
Phone: 864-407-1973