Revive Spa Hydration PLLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

REVIVE SPA HYDRATION PLLC

Doing business as

Revive Spa Hydration

Practice address

17609 29TH Avenue CT E
Tacoma, WA 98445-4622

Phone

(253) 257-8340

NPI assigned

Aug 4, 2021

Organization subpart

Yes

Parent organization

SECURE ALLIANCE PS LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Beth Ann Schubert, RN

Title

Owner

Phone

(253) 257-8340

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Revive Spa Hydration Doing business as

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

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1326712100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17609 29TH AVENUE CT E",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984454622",
            "telephone_number": "253-257-8340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17609 29TH AVENUE CT E",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984454622",
            "telephone_number": "253-257-8340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE SPA HYDRATION PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SECURE ALLIANCE PS LLC",
        "enumeration_date": "2021-08-04",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "SCHUBERT",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-257-8340",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "163WI0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WN1003X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Nutrition Support",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609417203",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive Spa Hydration",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Infusion Therapy Clinic/Center in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Infusion Therapy Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; 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.