Organization
REVIVE HEALTH CENTER OF UTAH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB TIPPETTS (ADMINISTRATOR)
(801) 820-6585
Entity
Organization
Contact information
Practice address
3080 N FAIRFIELD RD, SUITE 1, LAYTON, UT 84041-8694
(801) 820-6585
Mailing address
3080 N FAIRFIELD RD, SUITE 1, LAYTON, UT 84041-8694
(801) 820-6585
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
1851542872
UT
Other
Enumeration date
04/04/2014
Last updated
04/04/2014
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