Organization
REVITALIZED LLC
Active
Other names
Revitalized Specialty Infusion Services
Organization subpart
No
Provider details
NPI number
Authorized official
NATHANAEL FARRELLY (PRESIDENT)
(401) 773-9994
Entity
Organization
Contact information
Practice address
231 OLD TOWER HILL RD STE 202, WAKEFIELD, RI 02879-3708
(401) 773-9994
Mailing address
231 OLD TOWER HILL RD STE 202, WAKEFIELD, RI 02879-3708
(401) 773-9994
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
Primary
—
—
Other
Enumeration date
03/15/2023
Last updated
03/15/2023
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