Provider Demographics
NPI:1801781331
Name:THE KOKO BELLA PERMANENT MAKEUP AND LASH BAR
Entity type:Organization
Organization Name:THE KOKO BELLA PERMANENT MAKEUP AND LASH BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PEER RECOVERY SUPPORTER
Authorized Official - Prefix:
Authorized Official - First Name:CARNEKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-371-6698
Mailing Address - Street 1:257 KINGSMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9204
Mailing Address - Country:US
Mailing Address - Phone:330-371-6698
Mailing Address - Fax:
Practice Address - Street 1:1911 BALTIMORE REYNOLDSBURG RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8105
Practice Address - Country:US
Practice Address - Phone:614-452-9821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty