Healthcare Provider Details

I. General information

NPI: 1003738709
Provider Name (Legal Business Name): BLAQUE LUXURY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 S MARSHFIELD AVE APT 2S
CHICAGO IL
60620-0535
US

IV. Provider business mailing address

8002 S MARSHFIELD AVE APT 2S
CHICAGO IL
60620-0535
US

V. Phone/Fax

Practice location:
  • Phone: 800-807-8524
  • Fax:
Mailing address:
  • Phone: 800-807-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA LATATE
Title or Position: MANAGER
Credential:
Phone: 253-376-8919