Provider Demographics
NPI:1265168587
Name:RI-VIVE WELLNESS LLC
Entity type:Organization
Organization Name:RI-VIVE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACITIONER
Authorized Official - Prefix:
Authorized Official - First Name:IRMARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:707-470-2888
Mailing Address - Street 1:1250 OLIVER RD # 1116
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3467
Mailing Address - Country:US
Mailing Address - Phone:707-386-9644
Mailing Address - Fax:
Practice Address - Street 1:1652 W TEXAS ST STE 115
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5952
Practice Address - Country:US
Practice Address - Phone:707-470-2888
Practice Address - Fax:866-626-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care