1306655253 NPI number — AESTHETIC HAVEN, LLC

Table of content: (NPI 1306655253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306655253 NPI number — AESTHETIC HAVEN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AESTHETIC HAVEN, LLC
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:
1306655253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 INDUSTRIAL WAY
Provider Second Line Business Mailing Address:
THIRD FLOOR, SUITE 4, ROOM 4
Provider Business Mailing Address City Name:
TIVERTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-535-6104
Provider Business Mailing Address Fax Number:
401-340-1885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 INDUSTRIAL WAY
Provider Second Line Business Practice Location Address:
FL 3, SUITE 4, ROOM 4
Provider Business Practice Location Address City Name:
TIVERTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02878-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-535-6104
Provider Business Practice Location Address Fax Number:
401-340-1885
Provider Enumeration Date:
01/06/2025

Additional Information

Authorized Official

Authorized Official Last Name:
TURCOTTE
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTORATE OF FNP
Authorized Official Telephone Number:
401-835-5012

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WG0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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