Provider Demographics
NPI:1477793685
Name:REKINDLED SPIRITS INC
Entity Type:Organization
Organization Name:REKINDLED SPIRITS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MV
Authorized Official - Last Name:GENNARINI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:302-354-9054
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-0383
Mailing Address - Country:US
Mailing Address - Phone:302-354-9054
Mailing Address - Fax:
Practice Address - Street 1:41 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1017
Practice Address - Country:US
Practice Address - Phone:302-354-9054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE085434786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty