Provider Demographics
NPI:1285496307
Name:ZEN WELLNESS & RETREATS, INC
Entity type:Organization
Organization Name:ZEN WELLNESS & RETREATS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:EARLENE
Authorized Official - Last Name:PRIMOS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MASSAGE T
Authorized Official - Phone:219-440-6612
Mailing Address - Street 1:1952 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-1108
Mailing Address - Country:US
Mailing Address - Phone:219-794-4626
Mailing Address - Fax:
Practice Address - Street 1:7895 BROADWAY STE D
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5529
Practice Address - Country:US
Practice Address - Phone:219-440-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty