NPIMap

Organization Active NPI

Revive Wellness Center, LLC

  • Naturopath
  • New Haven, CT
National Provider Identifier
1649347360
Registry record updated Nov 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
NaturopathTaxonomy code 175F00000X
License
240 Issued in CT
Legal business name
REVIVE WELLNESS CENTER, LLC
Practice address
867 Whalley Ave
New Haven, CT 06515-1728
Phone
(203) 387-1540
Fax
(203) 387-8151
NPI assigned
Nov 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2018

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

Authorized official

Name
Emmanuel Sergentakis
Title
Owner
Phone
(203) 387-1540

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X 205 CT
NaturopathGroup: 193200000X MULTI-SPECIALTY GROUP 175F00000X 240 CT Primary

Addresses

Primary practice location

867 Whalley Ave
New Haven, CT 06515-1728

Mailing address

867 Whalley Ave
New Haven, CT 06515-1728
Phone (203) 387-1540

Other names 1

  • Dr. Artemis Morris, LLC Other name

National Provider Directory

National Provider Directory

Locations

867 Whalley Ave
New Haven, CT 06515
Phone (203) 387-1540

Practitioners & affiliated clinicians

Practitioners 6

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": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541376000000",
    "number": "1649347360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "867 WHALLEY AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065151728",
            "telephone_number": "203-387-1540",
            "fax_number": "203-387-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "867 WHALLEY AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065151728",
            "telephone_number": "203-387-1540",
            "fax_number": "203-387-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2018-11-05",
        "status": "A",
        "authorized_official_last_name": "SERGENTAKIS",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-387-1540"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "CT",
            "license": "205",
            "primary": false
        },
        {
            "code": "175F00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Naturopath",
            "state": "CT",
            "license": "240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Artemis Morris, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; 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.