Provider Demographics
NPI:1104691468
Name:SLIMMING GRACE LLC
Entity type:Organization
Organization Name:SLIMMING GRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:928-279-5076
Mailing Address - Street 1:PO BOX 3371
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-3371
Mailing Address - Country:US
Mailing Address - Phone:928-279-5076
Mailing Address - Fax:
Practice Address - Street 1:1901 JOHNSON AVE UNIT 3371
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86402-1616
Practice Address - Country:US
Practice Address - Phone:928-279-5076
Practice Address - Fax:949-695-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty