Healthcare Provider Details

I. General information

NPI: 1811730005
Provider Name (Legal Business Name): HEAVENLY HANDS MOBILE SPA LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MORRIS AVE STE 103B
SPRINGFIELD NJ
07081-1423
US

IV. Provider business mailing address

100 MORRIS AVE STE 103B
SPRINGFIELD NJ
07081-1423
US

V. Phone/Fax

Practice location:
  • Phone: 908-349-0504
  • Fax: 908-349-0504
Mailing address:
  • Phone: 908-349-0504
  • Fax: 908-349-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. SHANDA R GADSDEN
Title or Position: OWNER
Credential: MASSAGE THERAPIST
Phone: 908-349-0504