Provider Demographics
NPI:1740500933
Name:THE SPA AT BONCALDO'S
Entity type:Organization
Organization Name:THE SPA AT BONCALDO'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSE
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:BAKER-BONCALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-471-9515
Mailing Address - Street 1:76 BEALE STREET
Mailing Address - Street 2:
Mailing Address - City:WOLLASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02170
Mailing Address - Country:US
Mailing Address - Phone:617-471-9515
Mailing Address - Fax:
Practice Address - Street 1:76 BEALE ST
Practice Address - Street 2:
Practice Address - City:WOLLASTON
Practice Address - State:MA
Practice Address - Zip Code:02170-2617
Practice Address - Country:US
Practice Address - Phone:617-471-9515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty