Provider Demographics
NPI:1033235031
Name:THE ORCHID ROOM SPA, LLC
Entity Type:Organization
Organization Name:THE ORCHID ROOM SPA, LLC
Other - Org Name:THE ORCHID ROOM SPA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-566-8008
Mailing Address - Street 1:941 RIVER ST # 230
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:941 RIVER ST
Practice Address - Street 2:#230
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5906
Practice Address - Country:US
Practice Address - Phone:808-566-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU7561171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty