Provider Demographics
NPI:1780834192
Name:MEKKA, LLC
Entity type:Organization
Organization Name:MEKKA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-443-3933
Mailing Address - Street 1:2235 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1807
Mailing Address - Country:US
Mailing Address - Phone:206-443-3933
Mailing Address - Fax:206-443-9399
Practice Address - Street 1:2235 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1807
Practice Address - Country:US
Practice Address - Phone:206-443-3933
Practice Address - Fax:206-443-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00016569174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty