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General NPI Number Information
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NPI Number | 1508249467
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Entity Type | Organization
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Legal Business Name | PIPESTEM SPA & EVENT CENTER
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | HC 78 BOX 46A
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City | PIPESTEM
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State | WV
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Zip | 25979-9710
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Country | US
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Telephone | 304-466-1767
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 87 HC 78, BOX 46 A
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City | PIPESTEM
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State | WV
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Zip | 25979-0087
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Country | US
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Telephone | 304-466-1767
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNA FERRARACCIO
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Credential | LMP
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Telephone | 304-466-1767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2008-2377
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License Number State | WV
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