Provider Demographics
NPI:1508249467
Name:PIPESTEM SPA & EVENT CENTER
Entity Type:Organization
Organization Name:PIPESTEM SPA & EVENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:304-466-1767
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:HC 78, BOX 46 A
Mailing Address - City:PIPESTEM
Mailing Address - State:WV
Mailing Address - Zip Code:25979-0087
Mailing Address - Country:US
Mailing Address - Phone:304-466-1767
Mailing Address - Fax:
Practice Address - Street 1:HC 78 BOX 46A
Practice Address - Street 2:
Practice Address - City:PIPESTEM
Practice Address - State:WV
Practice Address - Zip Code:25979-9710
Practice Address - Country:US
Practice Address - Phone:304-466-1767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2008-2377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty