Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Liquid Lounge Hydration Dba Ideal Vitality Wellness

Organization Laboratory Management Specialist/Technologist · NPI 1720930183

Liquid Lounge Hydration Dba Ideal Vitality Wellness is a Laboratory Management Specialist/Technologist in Charlotte, North Carolina. Registered with an NPI since 2026.

In the registry since
2026
Specialties on file
2

Practice location Address checks out

5126 Park Rd Ste 2C
Charlotte, NC 28209-3748
Phone: (704) 247-7281
Fax: (704) 800-5655
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Laboratory Management Specialist/Technologist (primary) Taxonomy 246QL0900X
Nursing Care Agency Taxonomy 251J00000X

Record details

NPI number1720930183
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jennifer Guillaume — Operator · (704) 247-7281
Other names Ideal Vitality Wellness
NPI enumeratedFebruary 10, 2026
Last updated in NPPESFebruary 10, 2026
Certification dateFebruary 10, 2026
Mailing address5126 Park Rd Ste 2c, Charlotte, NC 28209-3748

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