Provider Demographics
NPI:1760840631
Name:PURE SERENITY DAY SPA, LLC
Entity Type:Organization
Organization Name:PURE SERENITY DAY SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTHA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-633-3068
Mailing Address - Street 1:500 E MAIN ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-1315
Mailing Address - Country:US
Mailing Address - Phone:304-743-8535
Mailing Address - Fax:
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:SUITE #5
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1315
Practice Address - Country:US
Practice Address - Phone:304-743-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty