Revive Therapeutics, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

REVIVE THERAPEUTICS, LLC

Practice address

300 Governors Hwy
South Windsor, CT 06074-2422

Phone

(860) 494-3800

NPI assigned

Mar 22, 2021

Organization subpart

No

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

Authorized official

Name

Cheryl Plank, LCSWNPI 1225460108

Title

Owner

Phone

(860) 494-3800

Specialties & licenses 1

Addresses

Locations

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.

• Cheryl Plank

  • Clinical Social Worker
  • South Windsor, CT
  • NPI 1225460108
  NPD Authorized official

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

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1881270858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2259",
            "city": "HEBRON",
            "state": "CT",
            "postal_code": "062488259",
            "telephone_number": "860-494-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 GOVERNORS HWY",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060742422",
            "telephone_number": "860-494-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE THERAPEUTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-22",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "PLANK",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-494-3800",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; 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.