Provider Demographics
NPI:1033923347
Name:THE SKINCRATIC METHOD, LLC
Entity type:Organization
Organization Name:THE SKINCRATIC METHOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-787-8466
Mailing Address - Street 1:767 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4888
Mailing Address - Country:US
Mailing Address - Phone:734-787-8466
Mailing Address - Fax:
Practice Address - Street 1:767 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4888
Practice Address - Country:US
Practice Address - Phone:734-787-8466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty