Provider Demographics
NPI:1568636231
Name:HEARTSONG MASSAGE, INC.
Entity Type:Organization
Organization Name:HEARTSONG MASSAGE, INC.
Other - Org Name:HEARTSONG MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:QUIRICONI
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-751-3313
Mailing Address - Street 1:1328 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3809
Mailing Address - Country:US
Mailing Address - Phone:360-751-3313
Mailing Address - Fax:360-636-5255
Practice Address - Street 1:1328 9TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3809
Practice Address - Country:US
Practice Address - Phone:360-751-3313
Practice Address - Fax:360-636-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA12619261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center