Ultimate Hydration and Wellness Clinic LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

ULTIMATE HYDRATION AND WELLNESS CLINIC LLC

Practice address

1905 Woodstock Rd Ste 6100
Roswell, GA 30075-5630

Phone

(470) 285-2750

Fax

(678) 404-5104

NPI assigned

Oct 18, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Folake Osibanjo, NP-CNPI 1144651894

Title

Owner/Member

Phone

(203) 450-3051

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Folake Osibanjo, FNP-C

  • Family Nurse Practitioner
  • Orlando, FL
  • NPI 1144651894
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1366105355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 WOODSTOCK RD STE 6100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300755630",
            "telephone_number": "470-285-2750",
            "fax_number": "678-404-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 WOODSTOCK RD STE 6100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300755630",
            "telephone_number": "470-285-2750",
            "fax_number": "678-404-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE HYDRATION AND WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-18",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "OSIBANJO",
        "authorized_official_first_name": "FOLAKE",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "203-450-3051",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "folake@ultimatehydrationandwellness.com",
            "affiliation": "N",
            "address_1": "1905 Woodstock Rd Ste 6100",
            "city": "Roswell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300755630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Roseline Umenyiora, RN
• Chelsea Marie Underwood
• Erin Underwood, OTR/L
• Isabella Nicole Underwood, BCBA, M.A.
• Unique Therapy Services, LLC

• Infusion Therapy Clinic/Center in Roswell, GA
• Providers in Roswell, GA by specialty
• Infusion Therapy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.