Provider Demographics
NPI:1841978699
Name:REVIVED AND RESTORED HEALTH, LLC
Entity type:Organization
Organization Name:REVIVED AND RESTORED HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOLISTIC HEALTH COACH
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-329-9833
Mailing Address - Street 1:6651 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2607
Mailing Address - Country:US
Mailing Address - Phone:770-329-9833
Mailing Address - Fax:
Practice Address - Street 1:6651 CAMERON RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2607
Practice Address - Country:US
Practice Address - Phone:770-329-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty