Provider Demographics
NPI:1568115673
Name:GREAT MASSAGE AND FACIAL SPA
Entity Type:Organization
Organization Name:GREAT MASSAGE AND FACIAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:IMOSE
Authorized Official - Last Name:OBAZEE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:470-643-1175
Mailing Address - Street 1:100 PAVILION WAY STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4560
Mailing Address - Country:US
Mailing Address - Phone:910-315-0402
Mailing Address - Fax:
Practice Address - Street 1:100 PAVILION WAY
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4559
Practice Address - Country:US
Practice Address - Phone:910-315-0402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty