Provider Demographics
NPI:1750019147
Name:REVIVE HEALTH CONCIERGE
Entity type:Organization
Organization Name:REVIVE HEALTH CONCIERGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASIAS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-717-5622
Mailing Address - Street 1:2800 E MADISON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4865
Mailing Address - Country:US
Mailing Address - Phone:206-717-5622
Mailing Address - Fax:855-631-4133
Practice Address - Street 1:2800 E MADISON ST STE 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4865
Practice Address - Country:US
Practice Address - Phone:206-717-5622
Practice Address - Fax:949-561-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty