NPIMap

Organization Active NPI

Revive Ministries Inc

  • Addiction (Substance Use Disorder) Counselor
  • Nicholasville, KY
National Provider Identifier
1063909067
Registry record updated Nov 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
REVIVE MINISTRIES INC
Practice address
111 Coconut Grove Drive
Nicholasville, KY 40356-2321
Phone
(859) 881-4505
Fax
(859) 241-1483
NPI assigned
Apr 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2022

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

Authorized official

Name
Todd Johns
Title
Ceo
Phone
(859) 354-9841

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

111 Coconut Grove Drive
Nicholasville, KY 40356-2321

Mailing address

800 S Main Street
Suite C
Nicholasville, KY 40356-1868
Phone (859) 241-5174

Other identifiers 3

IdentifierTypeStateIssuer
7100649290MedicaidKY
7100541540OtherKYMEDICAID GROUP
810626OtherKYBHSO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251022001063 KY Part B Supplier - Clinic/Group Practice 9436647435 Receives reassigned benefits from 8 practitioners
Practice locations: Nicholasville, KY

National Provider Directory

National Provider Directory
Tax ID family
Revive Ministries Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

800 S Main St
Ste C
Nicholasville, KY 40356
Phone (859) 241-3892

104 S 2nd St
Nicholasville, KY 40356
Phone (859) 241-3892

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669161600000",
    "number": "1063909067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S MAIN STREET",
            "address_2": "SUITE C",
            "city": "NICHOLASVILLE",
            "state": "KY",
            "postal_code": "403561868",
            "telephone_number": "859-241-5174",
            "fax_number": "859-305-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COCONUT GROVE DRIVE",
            "city": "NICHOLASVILLE",
            "state": "KY",
            "postal_code": "403562321",
            "telephone_number": "859-881-4505",
            "fax_number": "859-241-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MINISTRIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-16",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "JOHNS",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "859-354-9841"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100649290",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "7100541540",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHSO",
            "identifier": "810626",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nicholasville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.