Healthcare Provider Details

I. General information

NPI: 1487391827
Provider Name (Legal Business Name): IVHYDRATION2U, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 E X ST
DEER PARK TX
77536-3727
US

IV. Provider business mailing address

PO BOX 1463
DEER PARK TX
77536-1463
US

V. Phone/Fax

Practice location:
  • Phone: 832-788-4463
  • Fax:
Mailing address:
  • Phone: 832-788-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER TYSON
Title or Position: OWNER
Credential: RN
Phone: 832-788-4463