Provider Demographics
NPI:1477112886
Name:ZEN PLACE WELLNESS, LLC.
Entity Type:Organization
Organization Name:ZEN PLACE WELLNESS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:484-802-8979
Mailing Address - Street 1:405 ALDERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2247
Mailing Address - Country:US
Mailing Address - Phone:484-802-8979
Mailing Address - Fax:
Practice Address - Street 1:860 E SWEDESFORD RD FL 2
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2130
Practice Address - Country:US
Practice Address - Phone:484-802-8979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty