Provider Demographics
NPI:1679870638
Name:THE HEALING SANCTUARY SPA, INC
Entity Type:Organization
Organization Name:THE HEALING SANCTUARY SPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-730-2233
Mailing Address - Street 1:400 N TUSTIN AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3813
Mailing Address - Country:US
Mailing Address - Phone:714-730-2233
Mailing Address - Fax:714-730-2768
Practice Address - Street 1:400 N TUSTIN AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3813
Practice Address - Country:US
Practice Address - Phone:714-730-2233
Practice Address - Fax:714-730-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10904171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty