Provider Demographics
NPI:1942879572
Name:REVITALIZE IV SOLUTIONS, LLC
Entity Type:Organization
Organization Name:REVITALIZE IV SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-417-4556
Mailing Address - Street 1:7237 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3546
Mailing Address - Country:US
Mailing Address - Phone:773-417-4556
Mailing Address - Fax:855-958-5430
Practice Address - Street 1:7237 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3546
Practice Address - Country:US
Practice Address - Phone:773-417-4556
Practice Address - Fax:855-958-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12345678OtherINFUSION CLINIC