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General NPI Number Information
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NPI Number | 1992556369
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Entity Type | Organization
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Legal Business Name | REVIVE HYDRATION & WELLNESS LLC
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 2 MICHIGAN AVE W STE 201
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City | BATTLE CREEK
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State | MI
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Zip | 49017-3621
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Country | US
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Telephone | 269-282-9022
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Fax | 844-332-3887
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Provider Business Mailing Address
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Address Line | 1309 COFFEEN AVE STE 1417
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City | SHERIDAN
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State | WY
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Zip | 82801-5777
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Country | US
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Telephone | 269-282-9022
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Fax | 844-332-3887
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Authorized Official
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Title or Position | AGENT
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Name | MR. ANDREW PIERCE
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Credential |
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Telephone | 269-282-9022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care 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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