Provider Demographics
NPI:1952801128
Name:RENEW HYDRATION LLC
Entity Type:Organization
Organization Name:RENEW HYDRATION LLC
Other - Org Name:RENEW HYDRATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-837-8893
Mailing Address - Street 1:2601 W MOCKINGBIRD LN STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5630
Mailing Address - Country:US
Mailing Address - Phone:469-917-9166
Mailing Address - Fax:214-951-9720
Practice Address - Street 1:2601 W MOCKINGBIRD LN STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5630
Practice Address - Country:US
Practice Address - Phone:469-917-9166
Practice Address - Fax:214-951-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No3336H0001XSuppliersPharmacyHome Infusion Therapy PharmacyGroup - Multi-Specialty