Revive Injury & Wellness

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

REVIVE INJURY & WELLNESS

Practice address

2931 N Tenaya Way Ste 204
Las Vegas, NV 89128-0458

Phone

(725) 216-7859

Fax

(725) 216-7859

NPI assigned

Sep 2, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Chanel Lynn Balajadia

Title

Owner/Cfo

Phone

(725) 216-7859

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1662076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662076800000",
    "number": "1225759764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2931 N TENAYA WAY STE 204",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280458",
            "telephone_number": "725-216-7859",
            "fax_number": "725-216-7859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2931 N TENAYA WAY STE 204",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280458",
            "telephone_number": "725-216-7859",
            "fax_number": "725-216-7859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE INJURY & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-02",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A",
        "authorized_official_last_name": "BALAJADIA",
        "authorized_official_first_name": "CHANEL",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/CFO",
        "authorized_official_telephone_number": "725-216-7859",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alessandra Diana Reviglio, DMD
• Arianne Revilla, COTA
• Revitacare Health Centers
• Revive Behavior Health LLC
• Revive Crisis Clinic LLC
• Revive Medical Center LLC
• Revive Therapy Health and Wellness Services LLC
• Revived Minds LLC
• Revivify Wound Care and Soft Tissue Specialist
• Revivify Wound Care and Soft Tissue Specialty

• Multi-Specialty Clinic/Center in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Multi-Specialty Clinic/Center in Nevada

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