Provider Demographics
NPI:1447083829
Name:REBUILD ELEVATE ACHEIVE AND LIVE (REAL) LLC
Entity type:Organization
Organization Name:REBUILD ELEVATE ACHEIVE AND LIVE (REAL) LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-453-3608
Mailing Address - Street 1:7034 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5801
Mailing Address - Country:US
Mailing Address - Phone:240-749-5433
Mailing Address - Fax:
Practice Address - Street 1:7034 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5801
Practice Address - Country:US
Practice Address - Phone:240-749-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder