Revive Recovery

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

Legal business name

REVIVE RECOVERY

Practice address

7894 Murphy Rd
Melba, ID 83641-5167

Phone

(909) 241-7555

NPI assigned

Aug 2, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sherryl York, RN

Title

Owner

Phone

(909) 241-7555

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1023745908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2432 W BAY POINTE AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836515038",
            "telephone_number": "909-241-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7894 MURPHY RD",
            "city": "MELBA",
            "state": "ID",
            "postal_code": "836415167",
            "telephone_number": "909-241-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "SHERRYL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-241-7555",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanna Renee Dewey, DOULA
• Anneliese Taylor Haws, DDS
• Jamie Lynn Hendricks, FNP-BC, RN
• Jennifer L Minnis, LCSW
• Drostan N Orme, DDS
• Anne E Rushing, MSN, MAC, FNP
• Dan L Watt, DDS

• All providers in Melba, ID
• Addiction (Substance Use Disorder) Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.