Revitalize Mental Health Center LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

REVITALIZE MENTAL HEALTH CENTER LLC

Practice address

145 W Ostend St Ste 505
Baltimore, MD 21230-3764

Phone

(443) 354-2162

NPI assigned

Apr 25, 2022

Organization subpart

No

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

Authorized official

Name

Tasha Nicole Outlaw

Title

Owner

Phone

(443) 354-2162

Specialties & licenses 1

Addresses

Electronic endpoints 1

Tax ID family

Revitalize Mental Health Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Revitalize Mental Health Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
  • NPI 1316862154
  NPD tax ID

Locations

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

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1376287557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 W OSTEND ST STE 505",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212303764",
            "telephone_number": "443-354-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 W OSTEND ST STE 505",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212303764",
            "telephone_number": "443-354-2162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE MENTAL HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-25",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "OUTLAW",
        "authorized_official_first_name": "TASHA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-354-2162"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Outlook",
            "affiliation": "N",
            "address_1": "25 McGuirk Dr",
            "city": "Glen Burnie",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210607548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jameson Patrick Reuter, PHARM.D., BCPS
• Adrienne Reveal
• Gabriel Alexis Revelo
• Irene Francis Reville, L.C.S.W.-C
• Revitalize Mental Health Center LLC
• Revitalize Support Services, LLC
• Lori Beth Revitz, LCSW-C
• Revolution Rehabilitation and Sports Perforamance LLC
• Reward Health Services, LLC
• Reward Health Services, LLC

• Community/Behavioral Health Agency in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Community/Behavioral Health Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.