Provider Demographics
NPI:1932805389
Name:BANYAN MASSAGE HALE, LLC
Entity Type:Organization
Organization Name:BANYAN MASSAGE HALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-640-4750
Mailing Address - Street 1:71 BANYAN DR STE 115
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4693
Mailing Address - Country:US
Mailing Address - Phone:808-969-1044
Mailing Address - Fax:
Practice Address - Street 1:71 BANYAN DR STE 115
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4693
Practice Address - Country:US
Practice Address - Phone:808-969-1044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty