Provider Demographics
NPI:1295225134
Name:FACILITATED HEALING CTR LLC
Entity Type:Organization
Organization Name:FACILITATED HEALING CTR LLC
Other - Org Name:FACILITATED HEALING CTR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:857-234-4533
Mailing Address - Street 1:555 BROAD ST STE C
Mailing Address - Street 2:
Mailing Address - City:EAST WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-1301
Mailing Address - Country:US
Mailing Address - Phone:857-234-4533
Mailing Address - Fax:
Practice Address - Street 1:350 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2439
Practice Address - Country:US
Practice Address - Phone:857-234-4533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty