Provider Demographics
NPI:1295980167
Name:MERIDIANS SPA LLC
Entity type:Organization
Organization Name:MERIDIANS SPA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-661-7200
Mailing Address - Street 1:181 LAHAINALUNA RD STE D
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1585
Mailing Address - Country:US
Mailing Address - Phone:808-661-7200
Mailing Address - Fax:808-443-0494
Practice Address - Street 1:181 LAHAINALUNA RD STE D
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1585
Practice Address - Country:US
Practice Address - Phone:808-661-7200
Practice Address - Fax:808-443-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty