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General NPI Number Information
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NPI Number | 1306702733
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Entity Type | Organization
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Legal Business Name | REVIVE 906 LLC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 2940 E LAKE LANSING RD
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City | EAST LANSING
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State | MI
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Zip | 48823-7414
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Country | US
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Telephone | 906-200-1496
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Fax |
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Provider Business Mailing Address
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Address Line | 2940 E LAKE LANSING RD
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City | EAST LANSING
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State | MI
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Zip | 48823-7414
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Country | US
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Telephone | 906-200-1496
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH HART
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Credential |
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Telephone | 906-282-4372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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