Provider Demographics
NPI:1497146336
Name:REBALANCE BIOHEALTH LLC
Entity Type:Organization
Organization Name:REBALANCE BIOHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP NEW BUSINESS INITIATIVES
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:C
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-791-2775
Mailing Address - Street 1:8400 E CRESCENT PKWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2831
Mailing Address - Country:US
Mailing Address - Phone:817-791-2775
Mailing Address - Fax:
Practice Address - Street 1:8400 E CRESCENT PKWY
Practice Address - Street 2:SUITE 600
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2831
Practice Address - Country:US
Practice Address - Phone:817-791-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty