NPIMap

Organization Active NPI

Revive Behavioral Health and Wellness LLC

  • Clinical Social Worker
  • Grand Island, NE
National Provider Identifier
1548926801
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
REVIVE BEHAVIORAL HEALTH AND WELLNESS LLC
Practice address
215 N Wheeler Ave
Grand Island, NE 68801-5961
Phone
(308) 391-2280
Fax
(308) 832-4803
NPI assigned
Nov 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

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

Authorized official

Name
Angela Lyon, LICSWNPI 1063844645
Title
Owner
Phone
(308) 850-4330

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

215 N Wheeler Ave
Grand Island, NE 68801-5961

Mailing address

215 N Wheeler Ave
Grand Island, NE 68801-5961
Phone (308) 391-2280

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211215001055 NE Part B Supplier - Clinic/Group Practice 6305237918 Receives reassigned benefits from 2 practitioners
Practice locations: Grand Island, NE

National Provider Directory

National Provider Directory

Locations

215 N Wheeler Ave
Grand Island, NE 68801
Phone (308) 391-2280

223 W 3rd St
Grand Island, NE 68801
Phone (308) 850-4330

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1636588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663113600000",
    "number": "1548926801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N WHEELER AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688015961",
            "telephone_number": "308-391-2280",
            "fax_number": "308-832-4803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N WHEELER AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688015961",
            "telephone_number": "308-391-2280",
            "fax_number": "308-832-4803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE BEHAVIORAL HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-11",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A",
        "authorized_official_last_name": "LYON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "308-850-4330",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Island, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; 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.