NPIMap

Organization Active NPI

Revive Recovery Center LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Mesa, AZ
National Provider Identifier
1851007272
Registry record updated Apr 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
REVIVE RECOVERY CENTER LLC
Practice address
127 W Juanita Ave Ste 110
Mesa, AZ 85210-6114
Phone
(424) 212-9052
NPI assigned
Jan 30, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2023

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

Authorized official

Name
Brayden Younghusband
Title
Ceo
Phone
(000) 000-0000

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Multi-Specialty Clinic/Center 261QM1300X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

127 W Juanita Ave Ste 110
Mesa, AZ 85210-6114

Mailing address

127 W Juanita Ave Ste 110
Mesa, AZ 85210-6114
Phone (480) 470-6042

National Provider Directory

National Provider Directory
Tax ID family
Revive Recovery Center 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.

NPI Registry JSON

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

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682208000000",
    "number": "1851007272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 W JUANITA AVE STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106114",
            "telephone_number": "480-470-6042",
            "fax_number": "480-674-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 W JUANITA AVE STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106114",
            "telephone_number": "424-212-9052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE RECOVERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-04-23",
        "certification_date": "2023-04-23",
        "status": "A",
        "authorized_official_last_name": "YOUNGHUSBAND",
        "authorized_official_first_name": "BRAYDEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "000-000-0000"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2023; 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.