Healthcare Provider Details

I. General information

NPI: 1770411589
Provider Name (Legal Business Name): REVIVE IV SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PLAZA CIR
SANTEE SC
29142-9630
US

IV. Provider business mailing address

227 LANDMARK RD
CAMERON SC
29030-8385
US

V. Phone/Fax

Practice location:
  • Phone: 803-860-3588
  • Fax: 803-973-6214
Mailing address:
  • Phone: 803-860-3588
  • Fax: 803-973-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MORGAN MOORER
Title or Position: MANAGING MEMBER
Credential: RN
Phone: 803-860-3588