REVIVE AESTHETICS & SPA WASILLA, LLC (NPI# 1982237921) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982237921 |
| Entity Type | Organization |
| Organization Name | REVIVE AESTHETICS & SPA WASILLA, LLC |
| Practice Address |
1175 N Leatherleaf Loop Ste F Wasilla AK 99654-6527 |
| Practice Telephone | 9073737546 |
| Practice Fax Number | 9073737536 |
| Mailing Telephone | 9073737546 |
| Mailing Fax Number | 9073737536 |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-02-18 |
| Authorized Official Name | ERIN MORROW (OPERATIONS MANAGER) |
| Authorized Official Telephone | 9073737546 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Revive | Doing Business As Name - Organization |
| Street Address |
1175 N LEATHERLEAF LOOP STE F |
| City | WASILLA |
| State | AK |
| Zip Code | 99654-6527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003426784 | Colleen Maggie Newcity | Case Manager/Care Coordinator | 851 Westpoint Suite 310, Wasilla, AK 99654 | 2020-08-06 |
| 1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
| 1922648690 | Achieve Medical Alaska LLC | Clinic/Center | 1981 E Palmer, Suite 230, Wasilla, AK 99654 | 2020-01-10 |
| 1588205538 | Juan Carlos Garcia | Physician Assistant | 950 East Bogard Road, Suite 103, Wasilla, AK 99654 | 2019-10-01 |
| 1427610864 | Sharon Webb | Counselor | 705 S Knik Goose Bay Rd Suite K, Wasilla, AK 99654 | 2019-07-06 |
| 1306401864 | Logan Lee Cook | Peer Specialist | 2953 E Fairview Loop, Wasilla, AK 99654 | 2019-05-09 |
| 1053883595 | Moose Creek Medical Clinic LLC | Nurse Practitioner | 2341 S. Fern St., Suite 300, Wasilla, AK 99654 | 2018-12-21 |
| 1487124962 | Melissa A Stevens | Massage Therapist | 2201 W That Rd, Wasilla, AK 99654 | 2018-11-28 |
| 1609359561 | Audrey E Beers | Midwife | 2405 S. Knik Goose Bay Rd., Wasilla, AK 99654 | 2018-09-07 |
| 1093297418 | Karlee Janine Mccorry | Occupational Therapist | 613 S Knik-goose Bay Rd, Wasilla, AK 99654 | 2018-09-01 |
| Find all providers in zip 99654 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807862 | Turning Leaf Literacy Center, LLC | Clinic/Center | 690 E Susitna Ave, Wasilla, AK 99654-8124 | 2020-10-04 |
| 1831399203 | Bald Mountain View Assisted Living Home | Clinic/Center | 1160 N Stanley Road, Wasilla, AK 99654-7018 | 2007-07-23 |
| 1407195522 | Frontier Family Medicine | Clinic/Center | 545 N Knik St, Wasilla, AK 99654-7022 | 2013-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811596026 | Pivotal Care Partnership | Clinic/Center | 2925 Debarr Rd Ste 199, Anchorage, AK 99508-2959 | 2020-10-19 |
| 1821560160 | Ideal Option, Pllc | Clinic/Center | 3159 Tongass Ave, Ketchikan, AK 99901-5745 | 2018-12-27 |
| 1902389943 | Ideal Option, Pllc | Clinic/Center | 8585 Old Dairy Rd Ste 200, Juneau, AK 99801-8094 | 2018-09-14 |
| 1063911287 | Ideal Option, Pllc | Clinic/Center | 416 Frontage Rd # 400, Kenai, AK 99611-7770 | 2018-02-02 |
| 1255857876 | Vera Whole Health | Clinic/Center | 582 E 36th Ave Ste 203, Anchorage, AK 99503-4138 | 2017-08-15 |
| 1871020123 | Coburn Health Consulting LLC | Clinic/Center | 4401 Business Park Blvd # N-26, Anchorage, AK 99503-7172 | 2017-05-17 |
| 1063958452 | Southeast Alaska Regional Health Consortium | Clinic/Center | Cannery Site, Excursion Inlet, AK 99850 | 2017-01-10 |
| 1962948356 | Southeast Alaska Regional Health Consortium | Clinic/Center | Community Building, Port Protection, AK 99950 | 2017-01-10 |
| 1659817054 | Southeast Alaska Regional Health Consortium | Clinic/Center | Naukati Community Church, Naukati, AK 99950 | 2017-01-10 |
| 1932645512 | Southeast Alaska Regional Health Consortium | Clinic/Center | 105 Nw Kodiak Dr, Coffman Cove, AK 99918 | 2017-01-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.