Provider Demographics
NPI:1215621800
Name:SERENITY SPACE LLC.
Entity type:Organization
Organization Name:SERENITY SPACE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDOLNA
Authorized Official - Middle Name:ILONA
Authorized Official - Last Name:UJVARI
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:970-275-7956
Mailing Address - Street 1:415 MOUNTAIN VILLAGE BLVD UNIT 1244
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-9352
Mailing Address - Country:US
Mailing Address - Phone:970-275-7956
Mailing Address - Fax:
Practice Address - Street 1:700 W COLORADO AVE
Practice Address - Street 2:SUITE 244-A1
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-275-7956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty