Provider Demographics
NPI:1760237036
Name:RECREATE YOURSELF, LLC
Entity Type:Organization
Organization Name:RECREATE YOURSELF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RECREATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LRT, CTRS, CBIS
Authorized Official - Phone:919-412-2810
Mailing Address - Street 1:404 HAWKS BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3398
Mailing Address - Country:US
Mailing Address - Phone:919-412-2810
Mailing Address - Fax:
Practice Address - Street 1:404 HAWKS BLUFF CT
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3398
Practice Address - Country:US
Practice Address - Phone:984-208-6566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty