Provider Demographics
NPI:1073375267
Name:INNER PEACE SPA LLC
Entity Type:Organization
Organization Name:INNER PEACE SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:ME,LMT
Authorized Official - Phone:956-903-0123
Mailing Address - Street 1:5001 E EXPRESSWAY 83 STE 812
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-4584
Mailing Address - Country:US
Mailing Address - Phone:956-903-0123
Mailing Address - Fax:
Practice Address - Street 1:5001 E EXPRESSWAY 83 STE 812
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-4584
Practice Address - Country:US
Practice Address - Phone:956-903-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty