| Organization Name: | ANEW MEDSPA 2120 LLC |
| NPI Number: | 1043601271 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOUIS J MALCMACHER (OWNER) |
| Mailing Address: | 2120 S Green Rd South Euclid |
| State: | OH US |
| Postal Code: | 441213349 |
| Phone Number: | 2162555201 |
| Fax Number: | |
| NPI Enumeration Date: | 02/10/2015 |
| NPI Last Update Date: | 02/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 30.016769 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |