Provider Demographics
NPI:1619258563
Name:8REVIVE, LLC
Entity Type:Organization
Organization Name:8REVIVE, LLC
Other - Org Name:INFINITY REVIVE MASSAGE & WELLNESS CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREONI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-270-1893
Mailing Address - Street 1:161 MAA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3603
Mailing Address - Country:US
Mailing Address - Phone:808-270-1893
Mailing Address - Fax:808-270-1892
Practice Address - Street 1:161 MAA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3603
Practice Address - Country:US
Practice Address - Phone:808-270-1893
Practice Address - Fax:808-270-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAE-2645261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center