Provider Demographics
NPI:1255126777
Name:REVIVED WELLNESS: BIRTH AND BODYWORKS
Entity type:Organization
Organization Name:REVIVED WELLNESS: BIRTH AND BODYWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DOULA
Authorized Official - Phone:616-666-8834
Mailing Address - Street 1:750 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5582
Mailing Address - Country:US
Mailing Address - Phone:616-666-8834
Mailing Address - Fax:
Practice Address - Street 1:750 1ST ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5582
Practice Address - Country:US
Practice Address - Phone:616-666-8834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty