Provider Demographics
NPI: | 1023388576 |
---|---|
Name: | SAPPHIRE MASSAGE CENTER CORP |
Entity Type: | Organization |
Organization Name: | SAPPHIRE MASSAGE CENTER CORP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | PATRIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SANTINI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMT |
Authorized Official - Phone: | 305-556-6885 |
Mailing Address - Street 1: | 1840 W 49TH ST |
Mailing Address - Street 2: | SUITE# 514 |
Mailing Address - City: | HIALEAH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33012 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-556-6885 |
Mailing Address - Fax: | 305-556-6882 |
Practice Address - Street 1: | 1840 W 49TH ST |
Practice Address - Street 2: | SUITE# 514 |
Practice Address - City: | HIALEAH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33012 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-556-6885 |
Practice Address - Fax: | 305-556-6882 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-12-30 |
Last Update Date: | 2011-12-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | MM 27313 | 261QR0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |