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General NPI Number Information
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NPI Number | 1770411589
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Entity Type | Organization
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Legal Business Name | REVIVE IV SOLUTIONS LLC
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 150 PLAZA CIR
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City | SANTEE
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State | SC
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Zip | 29142-9630
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Country | US
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Telephone | 803-860-3588
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Fax | 803-973-6214
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Provider Business Mailing Address
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Address Line | 227 LANDMARK RD
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City | CAMERON
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State | SC
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Zip | 29030-8385
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Country | US
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Telephone | 803-860-3588
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Fax | 803-973-6214
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MORGAN MOORER
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Credential | RN
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Telephone | 803-860-3588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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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