NPIMap

Organization Active NPI

Koann Therapeutic Services Inc

Doing business as Revive Therapeutic Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Providence, RI
National Provider Identifier
1639843303
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
KOANN THERAPEUTIC SERVICES INC
Doing business as
Revive Therapeutic Services
Practice address
845 N Main St
Providence, RI 02904-5700
Phone
(401) 648-7172
Fax
(401) 648-0161
NPI assigned
Aug 5, 2021
Last updated
Jan 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

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

Authorized official

Name
Akos AntwiNPI 1760966436
Title
Provider/Ceo
Phone
(401) 648-7172

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Multi-Specialty Clinic/Center 261QM1300X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary
Registered Nurse 163W00000X NU
Child & Adolescent Psychiatric/Mental Health Registered Nurse 163WP0807X NU
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X NU

Addresses

Primary practice location

845 N Main St
Providence, RI 02904-5700

Mailing address

PO Box 3085
Pawtucket, RI 02861-0585

Other practice location 1

1009 Frederick RD
Catonsville, MD 21228-5055
Phone (401) 648-7172

Other practice location 2

53 Chester St
Somerville, MA 02144-3059
Phone (401) 648-7172

Other names 1

  • Revive Therapeutic Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA, MD3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20220912000255 RI Part B Supplier - Clinic/Group Practice 7113302282 Receives reassigned benefits from 13 practitioners
Practice locations: Providence, RI
O20250508002881 MA Part B Supplier - Clinic/Group Practice 7113302282 Receives reassigned benefits from 3 practitioners
Practice locations: Boston, MA
O20250520000646 MD Part B Supplier - Clinic/Group Practice 7113302282 Receives reassigned benefits from 2 practitioners
Practice locations: Catonsville, MD

National Provider Directory

National Provider Directory
Tax ID family
Koann Therapeutic Services2 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.

Locations

50 Redfield St
Ste 109
Dorchester, MA 02122
Phone (401) 648-7172

154 Waterman St
Providence, RI 02906
Phone (401) 272-1415

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768176000000",
    "number": "1639843303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3085",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028610585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N MAIN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029045700",
            "telephone_number": "401-648-7172",
            "fax_number": "401-648-0161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1009 Frederick RD",
            "address_purpose": "LOCATION",
            "city": "Catonsville",
            "state": "MD",
            "postal_code": "212285055",
            "country_code": "US",
            "telephone_number": "401-648-7172",
            "fax_number": "401-648-0161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "53 Chester St",
            "address_purpose": "LOCATION",
            "city": "Somerville",
            "state": "MA",
            "postal_code": "021443059",
            "country_code": "US",
            "telephone_number": "401-648-7172",
            "fax_number": "401-648-0161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KOANN THERAPEUTIC SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A",
        "authorized_official_last_name": "ANTWI",
        "authorized_official_first_name": "AKOS",
        "authorized_official_title_or_position": "PROVIDER/CEO",
        "authorized_official_telephone_number": "401-648-7172"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive Therapeutic Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revive Therapeutic Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2026; 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.