Provider Demographics
NPI:1083884589
Name:SERENE MOMENTS WELLNESS SPA
Entity Type:Organization
Organization Name:SERENE MOMENTS WELLNESS SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:CMT, CEO
Authorized Official - Phone:484-953-5109
Mailing Address - Street 1:29 CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-2035
Mailing Address - Country:US
Mailing Address - Phone:484-953-5109
Mailing Address - Fax:
Practice Address - Street 1:29 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-2035
Practice Address - Country:US
Practice Address - Phone:484-953-5109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty