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General NPI Number Information
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NPI Number | 1225218241
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Entity Type | Organization
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Legal Business Name | EARTH ESSENCE SPA THERAPY, LLC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 13747 50TH PL N
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-8155
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Country | US
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Telephone | 561-876-2421
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Fax | 561-282-6673
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Provider Business Mailing Address
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Address Line | 13747 50TH PL N
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-8155
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Country | US
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Telephone | 561-876-2421
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Fax | 561-282-6673
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUZETTE S PREBLE
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Credential | LMT
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Telephone | 561-790-3591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MA 50419
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License Number State | FL
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