Revive IV Hydration Therapy

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

REVIVE IV HYDRATION THERAPY

Practice address

4747 E Elliot Rd # 109
Phoenix, AZ 85044-1627

Phone

(480) 876-1148

NPI assigned

Feb 16, 2023

Organization subpart

No

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

Authorized official

Name

Samah Mohamed, M.S

Title

Owner

Phone

(720) 935-1490

Specialties & licenses 1

Addresses

Other names 1

• HYDRA the hydration spa Doing business as

Locations

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

{
    "created_epoch": "1676505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676505600000",
    "number": "1205534583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 E ELLIOT RD # 109",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850441627",
            "telephone_number": "480-876-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 E ELLIOT RD # 109",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850441627",
            "telephone_number": "480-876-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE IV HYDRATION THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-16",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "SAMAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-935-1490",
        "authorized_official_credential": "M.S"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HYDRA the hydration spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Revenity Medical Billing LLC
• Allison Revilla, RN
• Revive Care LLC
• Revive Health Clinics, PLLC
• Revive Integrated Care Services LLC
• Revivepath Recovery
• Revolution Health Medical Center
• Revolution Health Medical Center, PC
• Revolution Medical Center, Inc
• Revolution Medical Center, Inc

• Infusion Therapy Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Infusion Therapy Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; 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.