Provider Demographics
NPI:1962269480
Name:RE:VIBE WELLNESS COMPANY LLC
Entity type:Organization
Organization Name:RE:VIBE WELLNESS COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERFOZO
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-541-6000
Mailing Address - Street 1:439 W 4TH ST UNIT 692
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-5829
Mailing Address - Country:US
Mailing Address - Phone:440-541-6000
Mailing Address - Fax:
Practice Address - Street 1:30400 DETROIT RD STE 301
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1855
Practice Address - Country:US
Practice Address - Phone:440-541-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty