Provider Demographics
NPI:1902780695
Name:REANUITYLLC
Entity type:Organization
Organization Name:REANUITYLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:I
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-259-1403
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47341-0081
Mailing Address - Country:US
Mailing Address - Phone:765-259-1403
Mailing Address - Fax:
Practice Address - Street 1:205 S GREEN STREET
Practice Address - Street 2:
Practice Address - City:FOUTAINCITY
Practice Address - State:IN
Practice Address - Zip Code:47341-0081
Practice Address - Country:US
Practice Address - Phone:765-259-1403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health