Provider Demographics
NPI:1497106207
Name:ELITE TRANQUILITY HEALTH SPA LLC
Entity Type:Organization
Organization Name:ELITE TRANQUILITY HEALTH SPA LLC
Other - Org Name:THE SPA LOUNGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-580-9031
Mailing Address - Street 1:10437 S MILLERTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5733
Mailing Address - Country:US
Mailing Address - Phone:801-580-9031
Mailing Address - Fax:
Practice Address - Street 1:726 E 12200 S
Practice Address - Street 2:SUITE E
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9103
Practice Address - Country:US
Practice Address - Phone:801-495-9732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty