1841485570 NPI number — EUPHORIA SALON & DAYSPA, INC.

Table of content: MR. PHILIP EDWARD COMFORT H.I.S (NPI 1083972137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841485570 NPI number — EUPHORIA SALON & DAYSPA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EUPHORIA SALON & DAYSPA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841485570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2645 ONEAL LN BLDG D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-3187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-273-1900
Provider Business Mailing Address Fax Number:
225-273-5555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4905 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46123-9489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-718-0800
Provider Business Practice Location Address Fax Number:
317-718-8398
Provider Enumeration Date:
09/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SALES
Authorized Official First Name:
PHYLLIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
225-273-1900

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200953960A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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