Revival Mental Health LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

REVIVAL MENTAL HEALTH LLC

Practice address

16252 Magellan LN
Huntington Beach, CA 92647-3525

Phone

(949) 776-9476

NPI assigned

Jan 10, 2024

Last updated

Jan 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tyler Michaelis

Title

Managing Member

Phone

(949) 606-4681

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Revival Mental Health 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.

• Revival Mental Health LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Fountain Valley, CA
  • NPI 1922721083
  NPD tax ID

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

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1588435325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16252 MAGELLAN LN",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16252 MAGELLAN LN",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473525",
            "telephone_number": "949-776-9476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A",
        "authorized_official_last_name": "MICHAELIS",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "949-606-4681"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Renteria
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• Elsie Resendiz
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• Paulina Reveles, PA-C
• Suzanne Reyes-Ingwersen, DPT
• Evelyn Reyes
• Jeffrey Paul Reyes, FNP
• Jessica Reyes
• Lena Reyes

• Mental Illness Community Based Residential Treatment Facility in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Mental Illness Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.