| NPI | 1891370185 |
|---|---|
| Doing Business As | REVIVE LIFE HOUSE OUTPATIENT CENTER |
| Entity Type | Organization |
| Authorized Contact | TODD JOHNS CEO 859-354-9841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103T00000X Psychologist |
| 106H00000X Marriage & Family Therapist | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2022-11-18 |