Provider Demographics
NPI:1427403831
Name:INTENSE HOLISTIC HEALING HANDS
Entity Type:Organization
Organization Name:INTENSE HOLISTIC HEALING HANDS
Other - Org Name:INTENSE HOLISTIC HANDS SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JANUARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-449-7101
Mailing Address - Street 1:8245 VALLEY VIEW CIR APT 132C
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-5511
Mailing Address - Country:US
Mailing Address - Phone:313-449-7101
Mailing Address - Fax:
Practice Address - Street 1:8245 VALLEY VIEW CIR APT 132C
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-5511
Practice Address - Country:US
Practice Address - Phone:313-449-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service