# REVIVE AESTHETICS & SPA WASILLA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revive
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982237921
- **Authorized official:** ERIN MORROW (OPERATIONS MANAGER)
- **Authorized official phone:** (907) 373-7546

## Contact information

- **Practice address:** 1175 N LEATHERLEAF LOOP STE F, WASILLA, AK 99654-6527
- **Practice address phone:** (907) 373-7546
- **Practice address fax:** (907) 373-7536
- **Mailing address:** 1175 N LEATHERLEAF LOOP STE F, WASILLA, AK 99654-6527
- **Mailing address phone:** (907) 373-7546
- **Mailing address fax:** (907) 373-7536

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/18/2020
- **Last updated:** 02/18/2020