| NPI | 1306624358 |
|---|---|
| Former Legal Business Name | REVIVE IV, LLC |
| Entity Type | Organization |
| Authorized Contact | STEVEN CRAIG YOUNG General Counsel 612-367-7806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251F00000X Home Infusion |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2023-10-19 |