I-REVIVE PLLC (NPI# 1508473000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508473000 |
| Entity Type | Organization |
| Organization Name | I-REVIVE PLLC |
| Other Organization Name | MY MEDICAL MASSAGE |
| Practice Address |
525 Elliott Ave Grand Haven MI 49417-1038 |
| Practice Telephone | 6165661603 |
| Practice Fax Number | 6166078588 |
| Mailing Telephone | 6163778893 |
| Mailing Fax Number | 6166078588 |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2020-11-05 |
| Authorized Official Name | MS. AMANDA M CONVERSE I (CEO/FOUNDER) |
| Authorized Official Telephone | 6163778893 |
| Authorized Official Credential | LMT, CIMT, CPMT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251E00000X | Home Health | Agencies | ||
| Y | 2083P0500X |
Preventive Medicine Specialization: Preventive Medicine/Occupational Environmental Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | CAQH | 14997664 | 01 |
| Other Name | Type Code |
|---|---|
| my medical massage | Doing Business As Name - Organization |
| Street Address |
525 ELLIOTT AVE |
| City | GRAND HAVEN |
| State | MI |
| Zip Code | 49417-1038 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205435161 | Amanda M Converse I | Massage Therapist | 525 Elliott Ave, Grand Haven, MI 49417-1038 | 2020-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295393478 | Compassionate Christian Therapy, LLC | Social Worker | 16989 Robbins Rd, Grand Haven, MI 49417 | 2019-06-03 |
| 1275098501 | Christi Rene Fortenbacher | Massage Therapist | 318 S. Beacon Blvd, Grand Haven, MI 49417 | 2019-01-31 |
| 1518440650 | Jessica Hankins | Physical Therapy Assistant | 15773 Charles Ct, Grand Haven, MI 49417 | 2018-09-14 |
| 1558857466 | Christina Steege | Physical Therapist | 514 Friant St, Grand Haven, MI 49417 | 2018-07-03 |
| 1851822548 | Forefront Dermatology, S.c. | Dermatology | 1600 S Beacon Blvd, Suite 160, Grand Haven, MI 49417 | 2017-03-23 |
| 1982057907 | Jeremyn Duane Wiersma | Counselor | 1703 S. Despelder St., Grand Haven, MI 49417 | 2016-07-14 |
| 1760855225 | Lisa Costello | Dental Hygienist | 326 N. Ferry St, Grand Haven, MI 49417 | 2015-11-05 |
| 1508116088 | Great Lakes Chiropractic Health | Chiropractor | 15 S. Seventh St., Grand Haven, MI 49417 | 2012-09-12 |
| 1508120122 | Jonathan Stewart Rouwhorst | Family Medicine | 15161 Willowwood Ct, Grand Haven, MI 49417 | 2012-06-28 |
| 1104108836 | Employee Assistance Center Fulton | Psychologist | 321 Fulton, Grand Haven, MI 49417 | 2011-09-20 |
| Find all providers in zip 49417 | ||||
| Taxonomy Code | 2083P0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Preventive Medicine/Occupational Environmental Medicine |
| A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538766639 | Corporate Occupational Health PC | Preventive Medicine | 3501 Lake Eastbrook Blvd Se Ste 144, Grand Rapids, MI 49546-5939 | 2020-10-02 |
| 1770194375 | Healthstat Inc Huhtamaki-michigan | Preventive Medicine | 5700 W Shaffer Rd, Coleman, MI 48618-9706 | 2020-08-17 |
| 1487265088 | Healthstat Inc National Gypsum-national City | Preventive Medicine | 2375 S National City Rd, National City, MI 48748-9623 | 2020-08-17 |
| 1619494762 | Healthstat Onsite Clinic Keihin Capac | Preventive Medicine | 14898 Koehn Rd, Mussey, MI 48014-4310 | 2017-08-29 |
| 1174944953 | Healthstat On-site Clinic/unified Michigan | Preventive Medicine | 520 S. Coldwater Rd., Weidman, MI 48893 | 2013-12-23 |
| 1598018152 | Healthstat- Carson City Hospital | Preventive Medicine | 46 Elm St., Carson City, MI 48811 | 2012-10-19 |
| 1609129303 | Healthstat- Jedco | Preventive Medicine | 1615 Broadway Ave Nw, Grand Rapids, MI 49504-2026 | 2012-10-18 |
| 1083905541 | Rosalind Marie Cohen | Preventive Medicine | 1106 E Cook Rd, Grand Blanc, MI 48439-8368 | 2011-05-02 |
| 1629307251 | Michigan State University | Preventive Medicine | 346 Olin Health Ctr, East Circle Drive, East Lansing, MI 48824-1037 | 2009-12-10 |
| 1649421108 | Reynolds B Brissenden IIi | Preventive Medicine | 409 Timberlake Dr W, Holland, MI 49424-5338 | 2008-10-02 |
| Find all providers with the same taxonomy | ||||
| City | GRAND HAVEN |
| Zip Code | 49417 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.