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General NPI Number Information
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NPI Number | 1447179981
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Entity Type | Organization
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Legal Business Name | EMERGENT HOUSING SOULUTIONS LLC-BARE CANVAS ELECTROLYSIS
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Dates
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Enumeration Date | 07/10/2026
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Last Update Date | 07/10/2026
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Provider Practice Location Address
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Address Line | 6851 167TH ST STE 22
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City | TINLEY PARK
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State | IL
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Zip | 60477-2501
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Country | US
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Telephone | 779-900-7304
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 EAST ST
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City | CRETE
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State | IL
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Zip | 60417-2241
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Country | US
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Telephone | 779-900-7304
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Fax |
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Authorized Official
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Title or Position | OWNER/ELECTROLOGIST
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Name | LATOSHA C MALONE
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Credential | LE
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Telephone | 779-900-7304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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