Revitalized LLC

Primary specialty

Home Infusion AgencyTaxonomy code 251F00000X

Legal business name

REVITALIZED LLC

Doing business as

Revitalized Specialty Infusion Services

Practice address

231 Old Tower Hill Rd Ste 202
Wakefield, RI 02879-3708

Phone

(401) 773-9994

NPI assigned

Mar 15, 2023

Organization subpart

No

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

Authorized official

Name

Nathanael Farrelly

Title

President

Phone

(401) 773-9994

Specialties & licenses 2

Addresses

Other names 1

• Revitalized Specialty Infusion Services Doing business as

Locations

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

{
    "created_epoch": "1678838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678838400000",
    "number": "1740981877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 OLD TOWER HILL RD STE 202",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028793708",
            "telephone_number": "401-773-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 OLD TOWER HILL RD STE 202",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028793708",
            "telephone_number": "401-773-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-15",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A",
        "authorized_official_last_name": "FARRELLY",
        "authorized_official_first_name": "NATHANAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-773-9994"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revitalized Specialty Infusion Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Infusion Agency in Wakefield, RI
• Providers in Wakefield, RI by specialty
• Home Infusion Agency in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.