Healthcare Provider Details

I. General information

NPI: 1083884589
Provider Name (Legal Business Name): SERENE MOMENTS WELLNESS SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CHESTER PIKE
COLLINGDALE PA
19023-2035
US

IV. Provider business mailing address

29 CHESTER PIKE
COLLINGDALE PA
19023-2035
US

V. Phone/Fax

Practice location:
  • Phone: 484-953-5109
  • Fax:
Mailing address:
  • Phone: 484-953-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TINA MARIE FOSTER
Title or Position: PRESIDENT & CEO
Credential: CMT, CEO
Phone: 484-953-5109