Provider Demographics
NPI:1124576509
Name:REDEEMING WELLNESS LLC
Entity type:Organization
Organization Name:REDEEMING WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUMPAS
Authorized Official - Suffix:
Authorized Official - Credentials:NTP
Authorized Official - Phone:214-360-0600
Mailing Address - Street 1:5002 HORSESHOE TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3324
Mailing Address - Country:US
Mailing Address - Phone:214-360-0600
Mailing Address - Fax:
Practice Address - Street 1:5002 HORSESHOE TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-3324
Practice Address - Country:US
Practice Address - Phone:214-360-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001486133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty