Revive F W

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

REVIVE F W

Practice address

10907 Martindale Rd
Houston, TX 77048-2011

Phone

(713) 417-9092

NPI assigned

Jun 5, 2020

Last updated

Apr 14, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacqueline Miller

Title

Director

Phone

(713) 417-9092

Specialties & licenses 5

Addresses

Practitioners 1

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.

• Jackie Miller

  • Counselor
  • Houston, TX
  • NPI 1801678081
  NPD

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681430400000",
    "number": "1306460266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10907 MARTINDALE RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770482011",
            "telephone_number": "713-417-9092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10907 MARTINDALE RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770482011",
            "telephone_number": "713-417-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE F W",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-05",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "713-417-9092"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, 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": [],
    "endpoints": [],
    "other_names": []
}

• Revitalife Home Healthcare Services, LLC
• Revitalizaing Out-Patient Rehabilitation Facility
• Revitalized Resilience PLLC
• Revival Health Clinic
• Revival Homecare of Houson Inc.
• Revive Health
• Revive RX LLC (Revive Rx Pharmacy)
• Revive RX LLC
• Revolution EMS Inc
• Revolve Physical Therapy LP (Revolve Physical Therapy)

• Substance Use Disorder Rehabilitation Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; 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.