Provider Demographics
NPI:1720599467
Name:REWIRED
Entity Type:Organization
Organization Name:REWIRED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETREY
Authorized Official - Suffix:
Authorized Official - Credentials:BED, M-EDCI, C/AO
Authorized Official - Phone:740-915-7323
Mailing Address - Street 1:616 HEBRON RD STE E
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1444
Mailing Address - Country:US
Mailing Address - Phone:740-915-7323
Mailing Address - Fax:
Practice Address - Street 1:616 HEBRON RD STE E
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1444
Practice Address - Country:US
Practice Address - Phone:740-915-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty