Provider Demographics
NPI:1558709576
Name:TRANQUILITY WELLNESS GROUP
Entity Type:Organization
Organization Name:TRANQUILITY WELLNESS GROUP
Other - Org Name:ELEMENTS THERAPEUTIC MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-577-5700
Mailing Address - Street 1:12 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3308
Mailing Address - Country:US
Mailing Address - Phone:978-360-7345
Mailing Address - Fax:
Practice Address - Street 1:9 CORNERSTONE SQ
Practice Address - Street 2:BUILDING B, SUITE 800
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-1473
Practice Address - Country:US
Practice Address - Phone:978-577-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA958305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service