Revive Wellness Group

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

REVIVE WELLNESS GROUP

Practice address

5401 Vanalden Ave
Tarzana, CA 91356-3129

Phone

(818) 634-7091

NPI assigned

Mar 19, 2024

Organization subpart

No

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

Authorized official

Name

Kevork Shahinian

Title

Cfo

Phone

(818) 634-7091

Specialties & licenses 3

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1922868827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9528 TOPANGA CANYON BLVD",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "913114011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 VANALDEN AVE",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913563129",
            "telephone_number": "818-634-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WELLNESS GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-10-04",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "SHAHINIAN",
        "authorized_official_first_name": "KEVORK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "818-634-7091"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terry Ann Reimann, M.D.
• Angelee Kruger Reiner, MD
• Jehuda Renan, M.D.
• Belinda Reser
• Raymond Reveles
• Anthony Brenden Reyes, RADT
• Julie Reyes
• Natalie N Reyes
• Nicolette Anne Goto Reyes
• Jessica Reynaga, LPCC

• Substance Abuse Rehabilitation Facility in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.