Provider Demographics
NPI:1497237903
Name:SERENITY ROSE MOBILE SPA INC
Entity Type:Organization
Organization Name:SERENITY ROSE MOBILE SPA INC
Other - Org Name:SERENITY ROSE MASSAGE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:561-602-8953
Mailing Address - Street 1:7570 S FEDERAL HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6060
Mailing Address - Country:US
Mailing Address - Phone:561-542-2130
Mailing Address - Fax:
Practice Address - Street 1:7570 S FEDERAL HWY STE 4
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-6060
Practice Address - Country:US
Practice Address - Phone:561-542-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL52241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty