Provider Demographics
NPI:1568037620
Name:REKINDLE SUPPORTED LIVING
Entity Type:Organization
Organization Name:REKINDLE SUPPORTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DERITUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHALEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-702-9751
Mailing Address - Street 1:100 E CAMPUS BLVD SUITE 250
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235
Mailing Address - Country:US
Mailing Address - Phone:614-702-9751
Mailing Address - Fax:
Practice Address - Street 1:100 E CAMPUS BLVD SUITE 250
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235
Practice Address - Country:US
Practice Address - Phone:614-702-9751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health