Provider Demographics
NPI:1710624341
Name:SPAJUVENATE LLC
Entity Type:Organization
Organization Name:SPAJUVENATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENOZWAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-422-4447
Mailing Address - Street 1:1251 NW 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6542
Mailing Address - Country:US
Mailing Address - Phone:754-422-4447
Mailing Address - Fax:
Practice Address - Street 1:1000 E ATLANTIC BLVD STE 100
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7447
Practice Address - Country:US
Practice Address - Phone:754-422-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty