Provider Demographics
NPI:1780570200
Name:SACRED WATERS ACUPUNCTURE & HEALING CENTER
Entity type:Organization
Organization Name:SACRED WATERS ACUPUNCTURE & HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LIC. AC
Authorized Official - Prefix:
Authorized Official - First Name:ADALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAISONET
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC
Authorized Official - Phone:781-946-0077
Mailing Address - Street 1:488A HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-2837
Mailing Address - Country:US
Mailing Address - Phone:781-946-0077
Mailing Address - Fax:
Practice Address - Street 1:488A HIGH ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2837
Practice Address - Country:US
Practice Address - Phone:781-946-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty