| NPI | 1396212262 |
|---|---|
| Doing Business As | OC REVIVE WELLNESS |
| Entity Type | Organization |
| Authorized Contact | TYLER MICHAELIS CEO 949-606-4681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2018-10-30 |