NPIMap

Organization Active NPI

Revival Recovery Center Staffing LLC

  • Family Nurse Practitioner
  • Highland, MI
National Provider Identifier
1184398331
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
REVIVAL RECOVERY CENTER STAFFING LLC
Doing business as
REVIVAL RECOVERY CENTER STAFFING
Practice address
208 W Highland Rd Ste 102
Highland, MI 48357-4574
Phone
(833) 773-8482
Fax
(810) 775-0303
NPI assigned
Aug 2, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Authorized official

Name
Lisa A Perna, FNPNPI 1114298700
Title
Owner, Authorized Official
Phone
(248) 949-7177

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

208 W Highland Rd Ste 102
Highland, MI 48357-4574

Mailing address

208 W Highland Rd Ste 102
Highland, MI 48357-4574
Phone (833) 773-8482

Other practice location 1

5797 Felske Dr Ste 300
Brighton, MI 48116-9505
Phone (833) 773-8482

Other names 1

  • REVIVAL RECOVERY CENTER STAFFING Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210922003233 MI Part B Supplier - Clinic/Group Practice 7719384403 Receives reassigned benefits from 2 practitioners
Practice locations: Brighton, MI; Highland, MI

National Provider Directory

National Provider Directory

Locations

5797 Felske Dr
Ste 300
Brighton, MI 48116
Phone (833) 773-8482

208 W Highland Rd
Ste 102
Highland, MI 48357
Phone (833) 773-8482

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1184398331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 W HIGHLAND RD STE 102",
            "city": "HIGHLAND",
            "state": "MI",
            "postal_code": "483574574",
            "telephone_number": "833-773-8482",
            "fax_number": "810-775-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 W HIGHLAND RD STE 102",
            "city": "HIGHLAND",
            "state": "MI",
            "postal_code": "483574574",
            "telephone_number": "833-773-8482",
            "fax_number": "810-775-0303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5797 Felske Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "MI",
            "postal_code": "481169505",
            "country_code": "US",
            "telephone_number": "833-773-8482",
            "fax_number": "810-775-0303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVAL RECOVERY CENTER STAFFING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A",
        "authorized_official_last_name": "PERNA",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "248-949-7177",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REVIVAL RECOVERY CENTER STAFFING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Highland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; 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.