Salon One Twenty Four L.L.C.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SALON ONE TWENTY FOUR L.L.C.

Practice address

124 E Washington St
Camden, AR 71701-4010

Phone

(870) 454-7017

Fax

(501) 830-4033

NPI assigned

Oct 11, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lavon Cherale Green, PROSTHETICSPECIALISTNPI 1982366613

Title

Cranial Prosthetic Specialist

Phone

(870) 675-1246

Specialties & licenses 1

Addresses

Electronic endpoints 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lavon Cherale Green, PROSTHETICSPECIALIST

  • Prosthetics Case Management
  • Camden, AR
  • NPI 1982366613
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703548800000",
    "number": "1679235303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 444",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717110444",
            "telephone_number": "870-454-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E WASHINGTON ST",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717014010",
            "telephone_number": "870-454-7017",
            "fax_number": "501-830-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALON ONE TWENTY FOUR L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-11",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "LAVON",
        "authorized_official_middle_name": "CHERALE",
        "authorized_official_title_or_position": "CRANIAL PROSTHETIC SPECIALIST",
        "authorized_official_telephone_number": "870-675-1246",
        "authorized_official_credential": "PROSTHETICSPECIALIST"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "contactus@salononetwentyfour.com",
            "affiliation": "N",
            "address_1": "124 E Washington St",
            "city": "Camden",
            "state": "AR",
            "country_code": "US",
            "postal_code": "717014010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hairloss@salononetwentyfour.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "124 E Washington St",
            "city": "Camden",
            "state": "AR",
            "country_code": "US",
            "postal_code": "717014010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Angela Mashel Rich, L.A.C., L.A.D.A.C
• Kristin D Roberson, COTA
• Angela Robinson
• Angela Rogers, M.A. CCC-SLP
• Rollin Wycoff MD
• Gloria D Sams
• Jan Scantling, APRN
• Alyssa L Scott-Nutt, O.D.
• Natalie Sherman, BA SLP-A
• Mark A Shina, M.D.

• Durable Medical Equipment & Medical Supplies in Camden, AR
• Providers in Camden, AR by specialty
• Durable Medical Equipment & Medical Supplies in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.