NPIMap

Organization Active NPI

Revival Reentry

  • Voluntary or Charitable Agency
  • Ukiah, CA
National Provider Identifier
1477340735
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Voluntary or Charitable AgencyTaxonomy code 251V00000X
Legal business name
REVIVAL REENTRY
Practice address
521 Capps LN
Ukiah, CA 95482-7227
Phone
(707) 376-5086
NPI assigned
Apr 21, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Authorized official

Name
Ashley Elliott
Title
President/Ceo
Phone
(707) 376-5086

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Meals Provider 174200000X
Lodging Provider 177F00000X
Local Education Agency (LEA) 251300000X
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X
Voluntary or Charitable Agency 251V00000X Primary
In Home Supportive Care Agency 253Z00000X

Addresses

Primary practice location

521 Capps LN
Ukiah, CA 95482-7227

Mailing address

521 Capps LN
Ukiah, CA 95482-7227
Phone (707) 376-5086

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1745193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745193600000",
    "number": "1477340735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 CAPPS LN",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954827227",
            "telephone_number": "707-376-5086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 CAPPS LN",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954827227",
            "telephone_number": "707-376-5086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL REENTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-21",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "707-376-5086"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; 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.