Revive Recovery LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REVIVE RECOVERY LLC

Doing business as

MY Self Wellness

Practice address

3541 Bonita Bay Blvd Ste 200
Bonita Springs, FL 34134-1703

Phone

(239) 908-9958

NPI assigned

Mar 2, 2021

Organization subpart

No

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

Authorized official

Name

Christina Thomas

Title

Owner

Phone

(239) 908-9958

Specialties & licenses 4

Addresses

Other names 1

• MY Self Wellness Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1215522263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3541 BONITA BAY BLVD STE 200",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341341703",
            "telephone_number": "239-908-9958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3541 BONITA BAY BLVD STE 200",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341341703",
            "telephone_number": "239-908-9958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-02",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-908-9958"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.myselfwellness.center",
            "affiliation": "N",
            "address_1": "3541 Bonita Bay Blvd Ste 200",
            "city": "Bonita Springs",
            "state": "FL",
            "country_code": "US",
            "postal_code": "341341703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MY Self Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; 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.