Healthcare Provider Details

I. General information

NPI: 1295961589
Provider Name (Legal Business Name): RENEW SALON & DAY SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2154 N CENTER ST STE 203B
N CHARLESTON SC
29406-4080
US

IV. Provider business mailing address

2154 N CENTER ST STE 203B
N CHARLESTON SC
29406-4080
US

V. Phone/Fax

Practice location:
  • Phone: 843-225-9697
  • Fax:
Mailing address:
  • Phone: 843-225-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number30604
License Number StateSC

VIII. Authorized Official

Name: MS. DOMECIA UVONNE BROWN
Title or Position: OWNER
Credential:
Phone: 843-225-9697