Provider Demographics
NPI:1518306018
Name:REAWAKENINGS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:REAWAKENINGS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-925-3669
Mailing Address - Street 1:3600 RED ROAD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:855-925-3669
Mailing Address - Fax:646-304-5626
Practice Address - Street 1:3600 RED ROAD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:855-925-3669
Practice Address - Fax:646-304-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility