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General NPI Number Information
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NPI Number | 1770201501
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Entity Type | Organization
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Legal Business Name | PURE HYDRATION & WELLNESS LLC
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 2850 S ARLINGTON RD STE 102
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City | COVENTRY TOWNSHIP
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State | OH
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Zip | 44312-4719
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Country | US
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Telephone | 234-280-2550
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Fax | 234-280-2570
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Provider Business Mailing Address
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Address Line | 2850 S ARLINGTON RD STE 102
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City | COVENTRY TOWNSHIP
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State | OH
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Zip | 44312-4719
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Country | US
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Telephone | 234-280-2550
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Fax | 234-280-2570
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Authorized Official
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Title or Position | OWNER
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Name | TIARA BROADY
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Credential | NP
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Telephone | 234-280-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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