Provider Demographics
NPI:1992556369
Name:REVIVE HYDRATION & WELLNESS LLC
Entity type:Organization
Organization Name:REVIVE HYDRATION & WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-282-9022
Mailing Address - Street 1:1309 COFFEEN AVE STE 1417
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5777
Mailing Address - Country:US
Mailing Address - Phone:269-282-9022
Mailing Address - Fax:844-332-3887
Practice Address - Street 1:2 MICHIGAN AVE W STE 201
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3621
Practice Address - Country:US
Practice Address - Phone:269-282-9022
Practice Address - Fax:844-332-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No251J00000XAgenciesNursing Care