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General NPI Number Information
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NPI Number | 1063901072
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Entity Type | Organization
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Legal Business Name | ELITE BARBER SPA LLC
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 820 CENTRAL AVENUE SUITE E
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City | SUMMERVILLE
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State | SC
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Zip | 29483
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Country | US
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Telephone | 843-475-1033
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Fax |
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Provider Business Mailing Address
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Address Line | 117 NATCHEZ KUSSO ROAD
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City | RIDGEVILLE
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State | SC
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Zip | 29472
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Country | US
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Telephone | 843-475-1033
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. PATRICK NUGENT HILL
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Credential |
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Telephone | 843-475-1033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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