Salt Beach LLC

Primary specialty

VA Clinic/CenterTaxonomy code 261QV0200X

Legal business name

SALT BEACH LLC

Practice address

3570 Clemmons Rd Ste a
Clemmons, NC 27012-8044

Phone

(336) 293-4598

NPI assigned

May 2, 2024

Organization subpart

No

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

Authorized official

Name

Angela M. Brandon, CERTIFIED

Title

Halotherapist

Phone

(336) 970-8544

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1714608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1922855592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3570 CLEMMONS RD STE A",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128044",
            "telephone_number": "336-293-4598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3570 CLEMMONS RD STE A",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128044",
            "telephone_number": "336-293-4598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALT BEACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-02",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "BRANDON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "HALOTHERAPIST",
        "authorized_official_telephone_number": "336-970-8544",
        "authorized_official_credential": "CERTIFIED"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Rowe, LCSWA
• RSS/Clemmons Operations, LLC
• Ellena Vanessa Rubinstein, LCMHC
• William Ruiz
• Salem Mobility and Medical Supply Inc
• Shalisa Salters
• Issis Nallely Sanchez-Casiano, RBT
• Kathy Sanger, OT
• Emily Raye Sapp, MA,LPA, HSP-PA, BCBA
• Stuart McIver Saunders, M.D.

• VA Clinic/Center in Clemmons, NC
• Providers in Clemmons, NC by specialty
• VA Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; 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.