Provider Demographics
NPI:1811777808
Name:ADVANCED WELLNESS AND RECOVERY LLC
Entity type:Organization
Organization Name:ADVANCED WELLNESS AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:808-327-9609
Mailing Address - Street 1:75-5722 KUAKINI HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1721
Mailing Address - Country:US
Mailing Address - Phone:808-327-9609
Mailing Address - Fax:808-327-9607
Practice Address - Street 1:75-5722 KUAKINI HWY STE 103
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1721
Practice Address - Country:US
Practice Address - Phone:808-327-9609
Practice Address - Fax:808-327-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center