Revival Therapeutic Services LLC

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

REVIVAL THERAPEUTIC SERVICES LLC

Practice address

2885 Lindale Mount Holly Rd
Amelia, OH 45102-9707

Phone

(513) 401-4038

NPI assigned

May 27, 2021

Organization subpart

No

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

Authorized official

Name

Ryan Hall, LISWNPI 1871054924

Title

Owner

Phone

(513) 401-4038

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 4

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

• Ryan Hall

  • Social Worker
  • Florence, KY
  • NPI 1871054924
  NPD Authorized official
• Daniel Paul Becker

  • Mental Health Counselor
  • Cincinnati, OH
  • NPI 1548864564
  NPD (past)
• Brittney Kane

  • Counselor
  • Amelia, OH
  • NPI 1598233991
  NPD (past)
• Leann Kane VI, LISW

  • Clinical Social Worker
  • Florence, KY
  • NPI 1245844505
  NPD (past)

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

{
    "created_epoch": "1622073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1336715622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2885 LINDALE MOUNT HOLLY RD",
            "city": "AMELIA",
            "state": "OH",
            "postal_code": "451029707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2885 LINDALE MOUNT HOLLY RD",
            "city": "AMELIA",
            "state": "OH",
            "postal_code": "451029707",
            "telephone_number": "513-401-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL THERAPEUTIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-27",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-401-4038",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.revival-therapy.com",
            "affiliation": "N",
            "address_1": "2885 Lindale Mount Holly Rd",
            "city": "Amelia",
            "state": "OH",
            "country_code": "US",
            "postal_code": "451029707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael William Reardon
• Lance Reeves, DC
• Kateri T Reising
• Renal Treatment Centers-Illinois Inc
• Savana Driller Renners, DDS
• Emma Jo Rhoden, COTA/L
• Mollie Elizabeth Ridings, LSW
• Brittany Nicole Ridner, APRN
• Kayla Roberts
• Brooklynn Rosenberg, LMT

• All providers in Amelia, OH
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.