Healthcare Provider Details

I. General information

NPI: 1306702733
Provider Name (Legal Business Name): REVIVE 906 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E LAKE LANSING RD
EAST LANSING MI
48823-7414
US

IV. Provider business mailing address

2940 E LAKE LANSING RD
EAST LANSING MI
48823-7414
US

V. Phone/Fax

Practice location:
  • Phone: 906-200-1496
  • Fax:
Mailing address:
  • Phone: 906-200-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH HART
Title or Position: OWNER
Credential:
Phone: 906-282-4372