1922841345 NPI number — REZOLV HEALTH TREATMENT CENTER

Table of content: MS. ALYSSA ANNE RIDER MS, RD, LD (NPI 1952656654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922841345 NPI number — REZOLV HEALTH TREATMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REZOLV HEALTH TREATMENT CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922841345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 CHAMBLEE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29615-6731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1209 MOUNTAIN ROAD PL NE # 4658
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-7845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-784-5522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2024

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
RAVIKUMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL OWNER
Authorized Official Telephone Number:
866-784-5522

Provider Taxonomy Codes

  • Taxonomy code: 2083A0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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