Provider Demographics
NPI:1497648190
Name:DIVINE ESSENCE SPA LLC
Entity type:Organization
Organization Name:DIVINE ESSENCE SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:508-775-6961
Mailing Address - Street 1:63 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2415
Mailing Address - Country:US
Mailing Address - Phone:508-775-6961
Mailing Address - Fax:
Practice Address - Street 1:822 ROUTE 28 STE A&100B
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-5276
Practice Address - Country:US
Practice Address - Phone:508-775-6961
Practice Address - Fax:508-775-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service