Provider Demographics
NPI:1528477346
Name:ELLA'S THERAPEUTIC BATHS & SPA
Entity type:Organization
Organization Name:ELLA'S THERAPEUTIC BATHS & SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRIDAY-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-866-9943
Mailing Address - Street 1:707 S AVON ST STE B
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0476
Mailing Address - Country:US
Mailing Address - Phone:704-866-9943
Mailing Address - Fax:704-866-9754
Practice Address - Street 1:707 S AVON ST
Practice Address - Street 2:STE B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0475
Practice Address - Country:US
Practice Address - Phone:704-866-9943
Practice Address - Fax:704-866-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies