Revivd Recovery and Wellness Fort Wayne LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC

Practice address

402 E Main St
Fort Wayne, IN 46802-1910

Phone

(260) 298-8297

Fax

(260) 387-6154

NPI assigned

Apr 7, 2026

Last updated

Apr 7, 2026By 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

Ashley Brown, NPNPI 1265095897

Title

Ceo

Phone

(260) 298-8297

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 1

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.

• Ashley Kamea Lynn Brown, NP-C

  • Adult Health Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1265095897
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1775520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775520000000",
    "number": "1699617860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 E MAIN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021910",
            "telephone_number": "260-298-8297",
            "fax_number": "260-387-6154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 E MAIN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021910",
            "telephone_number": "260-298-8297",
            "fax_number": "260-387-6154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-07",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-298-8297",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip A Rettenmaier, DO
• Andrew Reum II
• Hugh Fredrick Reusser, MSW
• Susan Diane Reusser, LCSW
• Lucas Reust
• Alyssa Kindred Rex, AUD
• Claire Reyes
• Kara Reyes, DPT
• Tamara J Reynolds, FNP
• Houshmand Rezvani, M.D.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.