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General NPI Number Information
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NPI Number | 1720994395
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Entity Type | Organization
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Legal Business Name | MANE ILLUSIONS LLC
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 2800 BUSH RIVER RD STE 5
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City | COLUMBIA
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State | SC
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Zip | 29210-5662
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Country | US
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Telephone | 803-201-4702
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Fax |
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Provider Business Mailing Address
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Address Line | 227 GRANDFLORA LN
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City | COLUMBIA
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State | SC
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Zip | 29212-8541
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Country | US
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Telephone | 803-201-4702
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. NICOLE JOVAN ROBINSON
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Credential |
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Telephone | 803-201-4702
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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 |
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