| NPI | 1639843303 |
|---|---|
| Doing Business As | REVIVE THERAPEUTIC SERVICES |
| Entity Type | Organization |
| Authorized Contact | AKOS ANTWI Provider/CEO 401-648-7172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 163W00000X Registered Nurse |
| 163WP0807X Registered Nurse Psychiatric/Mental Health, Child & Adolescent | |
| 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult | |
| 251B00000X Case Management | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2024-09-24 |