Healthcare Provider Details

I. General information

NPI: 1922971613
Provider Name (Legal Business Name): STAY DRIPPED MOBILE IV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 E VERDE LN
PHOENIX AZ
85016-7627
US

IV. Provider business mailing address

1731 E VERDE LN
PHOENIX AZ
85016-7627
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-9825
  • Fax: 206-796-7443
Mailing address:
  • Phone: 602-688-9825
  • Fax: 206-796-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW SABA
Title or Position: MANAGING MEMBER / CEO
Credential:
Phone: 602-761-0492