Provider Demographics
NPI:1104422211
Name:ESSENCE OF CHANEL HAIR AND BEAUTY LLC
Entity type:Organization
Organization Name:ESSENCE OF CHANEL HAIR AND BEAUTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:321-914-9980
Mailing Address - Street 1:3000 MURRELL RD # 561272
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4431
Mailing Address - Country:US
Mailing Address - Phone:321-914-9980
Mailing Address - Fax:
Practice Address - Street 1:1175 N COURTENAY PKWY STE 2A
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4514
Practice Address - Country:US
Practice Address - Phone:321-914-9980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier