Provider Demographics
NPI:1134942832
Name:RE-HABIT WELLNESS, INC.
Entity type:Organization
Organization Name:RE-HABIT WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:702-376-6547
Mailing Address - Street 1:7400 PIRATES COVE RD APT 128
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0161
Mailing Address - Country:US
Mailing Address - Phone:702-376-6547
Mailing Address - Fax:
Practice Address - Street 1:7400 PIRATES COVE RD APT 128
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0161
Practice Address - Country:US
Practice Address - Phone:702-376-6547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty