Provider Demographics
NPI:1407087299
Name:CORPORATE MIND BODY SPA LLC
Entity type:Organization
Organization Name:CORPORATE MIND BODY SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-806-0962
Mailing Address - Street 1:600 RENAISSANCE CTR # 1
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48243-1815
Mailing Address - Country:US
Mailing Address - Phone:313-393-7995
Mailing Address - Fax:313-393-3208
Practice Address - Street 1:600 RENAISSANCE CTR # 1
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48243-1815
Practice Address - Country:US
Practice Address - Phone:313-393-7995
Practice Address - Fax:313-393-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty