Organization
REVIVE STEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN ELLSWORTH (OWNER)
(801) 550-7795
Entity
Organization
Contact information
Practice address
11469 N BROADLEAF HOLLOW LN, HIGHLAND, UT 84003-5632
(801) 550-7795
Mailing address
11469 N BROADLEAF HOLLOW LN, HIGHLAND, UT 84003-5632
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
Other
Enumeration date
10/18/2024
Last updated
10/18/2024
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