Provider Demographics
NPI:1639556814
Name:SERENITY GARDEN MASSAGE LLC
Entity Type:Organization
Organization Name:SERENITY GARDEN MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-598-1142
Mailing Address - Street 1:320 BROOKES DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 BROOKES DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2736
Practice Address - Country:US
Practice Address - Phone:314-598-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty