New Revive House, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

NEW REVIVE HOUSE, LLC

Practice address

44263 W. McClelland Drive
Maricopa, AZ 85138

Phone

(623) 264-5400

Fax

(623) 264-5700

NPI assigned

Feb 1, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Luamart Lewis

Title

Program Administrator

Phone

(623) 680-6797

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1568053734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44263 W. MCCLELLAND DRIVE",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "85138",
            "telephone_number": "623-264-5400",
            "fax_number": "623-264-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44263 W. MCCLELLAND DRIVE",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "85138",
            "telephone_number": "623-264-5400",
            "fax_number": "623-264-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW REVIVE HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-01",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "LUAMART",
        "authorized_official_title_or_position": "PROGRAM ADMINISTRATOR",
        "authorized_official_telephone_number": "623-680-6797",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Maricopa, AZ
• Providers in Maricopa, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.