Provider Demographics
NPI:1992182075
Name:HILO MASSAGE CLINIC AND DAY SPA LLC
Entity Type:Organization
Organization Name:HILO MASSAGE CLINIC AND DAY SPA LLC
Other - Org Name:SPA VIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIESS
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-756-2021
Mailing Address - Street 1:306 LEHUA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 LEHUA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2351
Practice Address - Country:US
Practice Address - Phone:808-930-3830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAE-2826225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty