Revitalize Ketamine Clinic Llc

LBN: Revitalize Ketamine Clinic Llc
Revitalize Ketamine Clinic Llc is an health care organization with primary practice located at 1800 S Milton Rd Ste 26 , Flagstaff AZ 86001-6340. The organization recently has only one registered license in Ambulatory Health Care Facilities / Multi-Specialty, which is considered as the primary health care specialty. Revitalize Ketamine Clinic Llc can be contacted via phone (928) 213-6931, or through Dubravcic, Jill Michelle via phone (928) 213-6931.

Contact Information

Primary practice address
1800 S Milton Rd Ste 26 Flagstaff AZ 86001-6340
Phone: (928) 213-6931
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Dubravcic, Jill Michelle FNP, PMHNP-BC
Phone: (928) 213-6931

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Multi-Specialty 261QM1300X

Profile Details

NPI number 1346911195
LBN Legal business name Revitalize Ketamine Clinic Llc
DBA Doing business as
Authorized official Dubravcic, Jill Michelle FNP, PMHNP-BC
Entity Organization
Organization subpart 1 No
Enumeration date Sep 22nd, 2021
Last updated Sep 22nd, 2021 - about 3 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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