Provider Demographics
NPI:1578229449
Name:MICAIAH SARAI, LLC
Entity type:Organization
Organization Name:MICAIAH SARAI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DEATON
Authorized Official - Suffix:
Authorized Official - Credentials:MMP, LMT
Authorized Official - Phone:804-994-3269
Mailing Address - Street 1:713 N COURTHOUSE RD.
Mailing Address - Street 2:STE 100
Mailing Address - City:N. CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4074
Mailing Address - Country:US
Mailing Address - Phone:804-994-3269
Mailing Address - Fax:
Practice Address - Street 1:713 N COURTHOUSE RD.
Practice Address - Street 2:STE 100
Practice Address - City:N. CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4074
Practice Address - Country:US
Practice Address - Phone:804-994-3269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty