Healthcare Provider Details

I. General information

NPI: 1104749993
Provider Name (Legal Business Name): ASH & UNWINE MASSAGE SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WINDEL DR STE 109D
RALEIGH NC
27609-4477
US

IV. Provider business mailing address

111 WINDEL DR STE 109D
RALEIGH NC
27609-4477
US

V. Phone/Fax

Practice location:
  • Phone: 919-637-5698
  • Fax: 919-635-1828
Mailing address:
  • Phone: 919-637-5698
  • Fax: 919-635-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TANZ'ANY JACOBS
Title or Position: OWNER
Credential: LMBT
Phone: 919-637-5698