Orange County Revive Services, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

ORANGE COUNTY REVIVE SERVICES, INC.

Practice address

23726 Birtcher Dr
Lake Forest, CA 92630-1771

Phone

(949) 606-4681

NPI assigned

Feb 14, 2023

Last updated

Feb 14, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

ORANGE COUNTY REVIVE SERVICES, INC.As reported in NPPES

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

Authorized official

Name

Tyler Michaelis

Title

Ceo

Phone

(949) 606-4681

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Orange County Revive Services Inc2 organizations share this tax ID, including this one

Part of

Orange County Revive Services Inc

Other organizations with this tax ID 1

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

• Orange County Revive Services, Inc.

  dba OC Revive

  • Substance Abuse Rehabilitation Facility
  • Lake Forest, CA
  • NPI 1508333477
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Orange County Revive Services, Inc.

  dba OC Revive

  • Substance Abuse Rehabilitation Facility
  • Lake Forest, CA
  • NPI 1508333477
  NPPES parent name

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.

• Alejandro Alva, M.D.

  • Psychiatry Physician
  • Costa Mesa, CA
  • NPI 1801816764
  NPD (past)

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

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1306543962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23726 BIRTCHER DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23726 BIRTCHER DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301771",
            "telephone_number": "949-606-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE COUNTY REVIVE SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ORANGE COUNTY REVIVE SERVICES, INC.",
        "enumeration_date": "2023-02-14",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "MICHAELIS",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-606-4681"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toks Onyekwuluje
• Suma Oommen, M.D.
• Optimal Function Physical Therapy
• Optimal Health Medical of Orange County
• Orange County Physiotherapy Services, P.C.
• Orange County Revive Services, Inc. (OC Revive)
• Alejandro Oropeza
• Ayme Orozco Gonzalez
• Yuliza Ortiz
• Paige Noel Osborne, SLP

• Mental Health Clinic/Center (Including Community Mental Health Center) in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

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