Provider Demographics
NPI:1689229585
Name:LAVENDER RETREAT, INC
Entity type:Organization
Organization Name:LAVENDER RETREAT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-627-8098
Mailing Address - Street 1:1236 PENNSYLVANIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2226
Mailing Address - Country:US
Mailing Address - Phone:703-627-8098
Mailing Address - Fax:202-847-0947
Practice Address - Street 1:1236 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2226
Practice Address - Country:US
Practice Address - Phone:703-627-8098
Practice Address - Fax:202-847-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty