Provider Demographics
NPI:1558576587
Name:BENEFICIAL ALCOVE MASSAGE AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:BENEFICIAL ALCOVE MASSAGE AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKTORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HODYNSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-429-0706
Mailing Address - Street 1:1310 HIGHWAY 96 E
Mailing Address - Street 2:#214
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3624
Mailing Address - Country:US
Mailing Address - Phone:651-429-0706
Mailing Address - Fax:612-788-4065
Practice Address - Street 1:1310 HIGHWAY 96 E
Practice Address - Street 2:#214
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3624
Practice Address - Country:US
Practice Address - Phone:651-429-0706
Practice Address - Fax:612-788-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103827OtherHEALTHPARTHNERS ID NUMBER