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General NPI Number Information
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NPI Number | 1013644806
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Entity Type | Organization
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Legal Business Name | ELITE RETREAT MASSAGE LLC
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 2100 E MAIN ST
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City | LANCASTER
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State | OH
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Zip | 43130-9351
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Country | US
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Telephone | 740-277-6933
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 STONEWALL CEMETERY RD SW
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City | LANCASTER
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State | OH
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Zip | 43130-9784
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Country | US
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Telephone | 740-215-6062
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA JUNE OLIVE
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Credential | CNP
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Telephone | 740-215-6062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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