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General NPI Number Information
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NPI Number | 1174427637
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Entity Type | Organization
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Legal Business Name | SALON SA- TREICE LLC
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 1923 W US HIGHWAY 50
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2927
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Country | US
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Telephone | 618-628-9499
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Fax |
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Provider Business Mailing Address
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Address Line | 1923 W US HIGHWAY 50
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2927
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Country | US
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Telephone | 618-628-9499
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA BROWN
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Credential | MPC
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Telephone | 618-628-9499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | NULL
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