# LIQUID LOUNGE HYDRATION DBA IDEAL VITALITY WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ideal Vitality Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720930183
- **Authorized official:** JENNIFER GUILLAUME BSN, RN (OPERATOR)
- **Authorized official phone:** (704) 247-7281

## Contact information

- **Practice address:** 5126 PARK RD STE 2C, CHARLOTTE, NC 28209-3748
- **Practice address phone:** (704) 247-7281
- **Practice address fax:** (704) 800-5655
- **Mailing address:** 5126 PARK RD STE 2C, CHARLOTTE, NC 28209-3748
- **Mailing address phone:** (704) 247-7281
- **Mailing address fax:** (704) 800-5655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246QL0900X | Laboratory Management Specialist/Technologist | — | NULL | Yes |
| 246QL0900X | Laboratory Management Specialist/Technologist | — | — | Yes |
| 251J00000X | Nursing Care Agency | — | NULL | — |

## Other

- **Enumeration date:** 02/10/2026
- **Last updated:** 02/10/2026