=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427590900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REJUVENATION MASSAGE BY FRANCES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2016
-----------------------------------------------------
Last Update Date | 11/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 CHACE AVENUE
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-407-1973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 CHACE AVE
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646-4463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-407-1973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPIST
-----------------------------------------------------
Name | MS. FRANCES MARIE ADAMS
-----------------------------------------------------
Credential | LICENSE 9897
-----------------------------------------------------
Telephone | 864-407-1973
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 9897
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------