Provider Demographics
NPI:1598595894
Name:IV REVIVAL SERVICES PLLC
Entity type:Organization
Organization Name:IV REVIVAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:607-329-5414
Mailing Address - Street 1:2781 E SAN TAN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4069
Mailing Address - Country:US
Mailing Address - Phone:607-329-5414
Mailing Address - Fax:
Practice Address - Street 1:7373 N SCOTTSDALE RD STE D235
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-5515
Practice Address - Country:US
Practice Address - Phone:607-329-5414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion