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General NPI Number Information
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NPI Number | 1225627920
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Entity Type | Organization
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Legal Business Name | REVIVE HYDRATION SPA LLC
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Dates
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Enumeration Date | 01/16/2021
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 5650 S FRANKLIN RD STE 300C
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-8620
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Country | US
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Telephone | 317-245-7353
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Fax | 317-527-9214
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Provider Business Mailing Address
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Address Line | 5650 S FRANKLIN RD STE 300C
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-8620
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Country | US
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Telephone | 317-245-7353
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Fax | 317-527-9214
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Authorized Official
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Title or Position | OWNER
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Name | JANE ARCHER
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Credential | NP
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Telephone | 317-245-7353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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