Provider Demographics
NPI:1619756921
Name:OPULENT BODY WELLNESS AND DAY SPA
Entity Type:Organization
Organization Name:OPULENT BODY WELLNESS AND DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FELISE
Authorized Official - Middle Name:MONOCELL
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:919-532-9837
Mailing Address - Street 1:1307 HAZELNUT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4933
Mailing Address - Country:US
Mailing Address - Phone:919-532-9837
Mailing Address - Fax:
Practice Address - Street 1:325 N FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-6065
Practice Address - Country:US
Practice Address - Phone:252-366-7001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOIR PROPERTIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty