Provider Demographics
NPI:1609414994
Name:REBOUND HEALTH AND WELLNESS SERVICES INC
Entity Type:Organization
Organization Name:REBOUND HEALTH AND WELLNESS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELSTON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-459-9866
Mailing Address - Street 1:4645 NANNIE HELEN BURROUGHS AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3622
Mailing Address - Country:US
Mailing Address - Phone:202-459-9866
Mailing Address - Fax:888-316-9392
Practice Address - Street 1:4645 NANNIE HELEN BURROUGHS AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3622
Practice Address - Country:US
Practice Address - Phone:202-459-9866
Practice Address - Fax:888-316-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC400316002097OtherBASIC BUSINESS LICENSE