Provider Demographics
NPI:1023552361
Name:MASSAGE SERENITY
Entity Type:Organization
Organization Name:MASSAGE SERENITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANEA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-353-2132
Mailing Address - Street 1:20245 W. 12 MILE RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076
Mailing Address - Country:US
Mailing Address - Phone:248-281-3730
Mailing Address - Fax:
Practice Address - Street 1:20245 W. 12 MILE RD
Practice Address - Street 2:SUITE 113
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:248-281-3730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health