NPIMap

Organization Active NPI

Revive Health Center of Utah LLC

  • Licensed Practical Nurse
  • Layton, UT
National Provider Identifier
1184042236
Registry record updated Apr 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
1851542872 Issued in UT
Legal business name
REVIVE HEALTH CENTER OF UTAH LLC
Practice address
3080 N Fairfield Rd
Suite 1
Layton, UT 84041-8694
Phone
(801) 820-6585
NPI assigned
Apr 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jacob Tippetts
Title
Administrator
Phone
(801) 820-6585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical NurseGroup: 193200000X MULTI-SPECIALTY GROUP 164W00000X 1851542872 UT Primary

Addresses

Primary practice location

3080 N Fairfield Rd
Suite 1
Layton, UT 84041-8694

Mailing address

3080 N Fairfield Rd
Suite 1
Layton, UT 84041-8694
Phone (801) 820-6585

National Provider Directory

National Provider Directory

Locations

3080 N Fairfield Rd
Ste 1
Layton, UT 84041
Phone (801) 820-6585

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396569600000",
    "number": "1184042236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3080 N FAIRFIELD RD",
            "address_2": "SUITE 1",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840418694",
            "telephone_number": "801-820-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 N FAIRFIELD RD",
            "address_2": "SUITE 1",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840418694",
            "telephone_number": "801-820-6585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE HEALTH CENTER OF UTAH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-04",
        "last_updated": "2014-04-04",
        "status": "A",
        "authorized_official_last_name": "TIPPETTS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "801-820-6585",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "UT",
            "license": "1851542872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Layton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.