Core Revive

LBN: Core Revive / Soul Revive Llc
Core Revive is an health care organization with primary practice located at 16 Queens Ln , Petaluma CA 94952-1047. The organization recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Diabetes Educator, Nursing Service Providers / Nutrition Support. Nursing Service Providers / Nutrition Support is the primary health care specialty. Core Revive / Soul Revive Llc can be contacted via phone (707) 559-5347, or through Diehl, Philip Anthony via phone (415) 250-7118.

Contact Information

Primary practice address
16 Queens Ln Petaluma CA 94952-1047
Phone: (707) 559-5347
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Diehl, Philip Anthony Registered Nurse (RN)
Phone: (415) 250-7118

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Diabetes Educator 163WD0400X 846331 California
Nursing Service Providers / Nutrition Support 163WN1003X 846331 California

Profile Details

NPI number 1154826980
LBN Legal business name Core Revive / Soul Revive Llc
DBA Doing business as Core Revive
Authorized official Diehl, Philip Anthony Registered Nurse (RN)
Entity Organization
Organization subpart 1 No
Enumeration date Mar 26th, 2018
Last updated Jun 11th, 2019 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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