Provider Demographics
NPI:1346954211
Name:MASSAGE HEILUNG LLC
Entity Type:Organization
Organization Name:MASSAGE HEILUNG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:AKPOROGUAFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-600-8623
Mailing Address - Street 1:2432B RIVER OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3602
Mailing Address - Country:US
Mailing Address - Phone:337-600-8623
Mailing Address - Fax:
Practice Address - Street 1:210 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2312
Practice Address - Country:US
Practice Address - Phone:337-600-8623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty