Provider Demographics
NPI:1972256162
Name:HEALING GROUNDS CENTER CORP
Entity type:Organization
Organization Name:HEALING GROUNDS CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORALESKY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:262-586-0199
Mailing Address - Street 1:7510 288TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9550
Mailing Address - Country:US
Mailing Address - Phone:262-586-0199
Mailing Address - Fax:
Practice Address - Street 1:7510 288TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9550
Practice Address - Country:US
Practice Address - Phone:262-586-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty