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General NPI Number Information
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NPI Number | 1972856987
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Entity Type | Organization
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Legal Business Name | HAILE VILLAGE SPA & SALON
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 5207 SW 91ST TER
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City | GAINESVILLE
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State | FL
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Zip | 32608-7125
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Country | US
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Telephone | 352-335-5025
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Fax | 352-335-2445
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Provider Business Mailing Address
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Address Line | 5207 SW 91ST TER
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City | GAINESVILLE
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State | FL
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Zip | 32608-7125
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Country | US
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Telephone | 352-335-5025
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Fax | 352-335-2445
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Authorized Official
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Title or Position | SPA DIRECTOR/SPA MANAGER
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Name | KATELYN VILARDELL
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Credential |
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Telephone | 352-335-5025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | MM 29063
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License Number State | FL
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