Revive Stem

Primary specialty

Home Infusion AgencyTaxonomy code 251F00000X

Legal business name

REVIVE STEM

Practice address

11469 N Broadleaf Hollow LN
Highland, UT 84003-5632

Phone

(801) 550-7795

NPI assigned

Oct 18, 2024

Organization subpart

No

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

Authorized official

Name

Kristen Ellsworth

Title

Owner

Phone

(801) 550-7795

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1729209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1821819210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11469 N BROADLEAF HOLLOW LN",
            "city": "HIGHLAND",
            "state": "UT",
            "postal_code": "840035632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11469 N BROADLEAF HOLLOW LN",
            "city": "HIGHLAND",
            "state": "UT",
            "postal_code": "840035632",
            "telephone_number": "801-550-7795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE STEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-18",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A",
        "authorized_official_last_name": "ELLSWORTH",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-550-7795"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Preservemd LLC
• Eva M Price, CPM, LDEM
• Martha Proctor
• Reese & Weaver DDS LLC
• Christine Kerr Renfro, APRN, C-FNP
• Hayley Rice, DMD
• Ridley'S Family Markets, Inc
• RJ Dental Holdings LLC
• Hannah Rodgers
• Nicholas Clark Rowley, DMD

• Home Infusion Agency in Highland, UT
• Providers in Highland, UT by specialty
• Home Infusion Agency in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; 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.