Healthcare Provider Details

I. General information

NPI: 1669310470
Provider Name (Legal Business Name): HYDRATION INFUSION LOUNGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 SOCIETY DR
CLAYMONT DE
19703-1743
US

IV. Provider business mailing address

1302 SOCIETY DR
CLAYMONT DE
19703-1743
US

V. Phone/Fax

Practice location:
  • Phone: 484-429-1435
  • Fax:
Mailing address:
  • Phone: 484-429-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LANEKA RAISON
Title or Position: NURSE PRACTITIONER/OWNER
Credential: CRNP
Phone: 484-429-1435