MEDICARE: MOB BEAUTY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2278H0200X	Home Health Certified Respiratory Therapist

General Provider Information

NPI Number	:	1952173411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOB BEAUTY LLC

Provider Business Mailing Address
First Line	:	218 E HOME AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48505-2716
Country	:	US
Telephone Number	:	810-610-4144
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 E HOME AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48505-2716
Country	:	US
Telephone Number	:	810-610-4144
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANTIA BLUEITT
Credential	:
Telephone Number	:	810-610-4144

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	10/26/2023

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