Healthcare Provider Details

I. General information

NPI: 1982844437
Provider Name (Legal Business Name): EL HAIJJ SALON ANDS SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 20TH ST
HUNTINGTON WV
25703-2021
US

IV. Provider business mailing address

PO BOX 8098
HUNTINGTON WV
25705-0098
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-7553
  • Fax:
Mailing address:
  • Phone: 304-522-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWV

VIII. Authorized Official

Name: MS. SUSAN JOYCE HAGE
Title or Position: OWNER
Credential:
Phone: 304-522-7553