Provider Demographics
NPI:1225218241
Name:EARTH ESSENCE SPA THERAPY, LLC
Entity Type:Organization
Organization Name:EARTH ESSENCE SPA THERAPY, LLC
Other - Org Name:EARTH ESSENCE SPA THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PREBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:561-790-3591
Mailing Address - Street 1:13747 50TH PL N
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8155
Mailing Address - Country:US
Mailing Address - Phone:561-876-2421
Mailing Address - Fax:561-282-6673
Practice Address - Street 1:13747 50TH PL N
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8155
Practice Address - Country:US
Practice Address - Phone:561-876-2421
Practice Address - Fax:561-282-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 50419320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities