| Organization Name: | REVIVE HEALTH CENTER OF UTAH LLC |
| NPI Number: | 1184042236 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACOB TIPPETTS (ADMINISTRATOR) |
| Mailing Address: | 3080 N Fairfield Rd Suite 1 Layton |
| State: | UT US |
| Postal Code: | 840418694 |
| Phone Number: | 8018206585 |
| Fax Number: | |
| NPI Enumeration Date: | 04/04/2014 |
| NPI Last Update Date: | 04/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 164W00000X |
| License Number: | 1851542872 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Licensed Practical Nurse |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |