Healthcare Provider Details

I. General information

NPI: 1205759321
Provider Name (Legal Business Name): SALONDEPOSHAA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E BARDIN RD UNIT 182751
ARLINGTON TX
76096-4312
US

IV. Provider business mailing address

1301 E BARDIN RD UNIT 182751
ARLINGTON TX
76096-4312
US

V. Phone/Fax

Practice location:
  • Phone: 909-707-8774
  • Fax:
Mailing address:
  • Phone: 909-704-8774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: PORTIA ANKRAH
Title or Position: MANAGER
Credential:
Phone: 909-704-8774