Provider Demographics
NPI:1073222568
Name:REFRESH IV HYDRATION SERVICES LLC
Entity Type:Organization
Organization Name:REFRESH IV HYDRATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:BINCY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARUGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:469-972-7252
Mailing Address - Street 1:3960 BROADWAY BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2587
Mailing Address - Country:US
Mailing Address - Phone:469-972-7252
Mailing Address - Fax:
Practice Address - Street 1:3960 BROADWAY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2587
Practice Address - Country:US
Practice Address - Phone:469-972-7252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty