Provider Demographics
NPI:1235976564
Name:LOVE AND LIFE WELLNESS SPA
Entity type:Organization
Organization Name:LOVE AND LIFE WELLNESS SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:WALETTRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-397-7104
Mailing Address - Street 1:8 THE GRN STE 11589
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:288 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7311
Practice Address - Country:US
Practice Address - Phone:267-673-4659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty