Provider Demographics
NPI:1013644806
Name:ELITE RETREAT MASSAGE LLC
Entity Type:Organization
Organization Name:ELITE RETREAT MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:OLIVE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:740-215-6062
Mailing Address - Street 1:1950 STONEWALL CEMETERY RD SW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9784
Mailing Address - Country:US
Mailing Address - Phone:740-215-6062
Mailing Address - Fax:
Practice Address - Street 1:2100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9351
Practice Address - Country:US
Practice Address - Phone:740-277-6933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service