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General NPI Number Information
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NPI Number | 1942651765
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Entity Type | Organization
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Legal Business Name | SALON HEAVENLY HANDS/HEAVENLY HANDS MASSAGE & ACUPUNCTURE
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 6727 WINTHROP ST
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City | DETROIT
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State | MI
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Zip | 48228-3767
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Country | US
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Telephone | 313-995-2374
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Fax | 313-865-0666
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Provider Business Mailing Address
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Address Line | 6727 WINTHROP ST
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City | DETROIT
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State | MI
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Zip | 48228-3767
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Country | US
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Telephone | 313-995-2374
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Fax | 313-865-0666
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LASHAUNA DONISE MOORE
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Credential | LMT
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Telephone | 313-995-2374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7501006893
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License Number State | MI
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