Provider Demographics
NPI:1679800528
Name:VIDELLS DAY SPA
Entity Type:Organization
Organization Name:VIDELLS DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN
Authorized Official - Prefix:MS
Authorized Official - First Name:VIDELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-656-1784
Mailing Address - Street 1:33B TROLLEY SQ
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3352
Mailing Address - Country:US
Mailing Address - Phone:302-656-1784
Mailing Address - Fax:
Practice Address - Street 1:33B TROLLEY SQ
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3352
Practice Address - Country:US
Practice Address - Phone:302-656-1784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty