Provider Demographics
NPI:1518618396
Name:RE-HYDRATE WELLNESS LLC
Entity Type:Organization
Organization Name:RE-HYDRATE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYODELE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-309-2484
Mailing Address - Street 1:574 IRVINE LOOP
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7699
Mailing Address - Country:US
Mailing Address - Phone:614-309-2484
Mailing Address - Fax:
Practice Address - Street 1:1329 CHERRY WAY DR STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6781
Practice Address - Country:US
Practice Address - Phone:614-317-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center