Revival Recovery Services

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

360103AN Issued in CA

Legal business name

REVIVAL RECOVERY SERVICES

Practice address

12350 Indian River Dr
Apple Valley, CA 92308-6771

Phone

(760) 887-1632

Fax

(760) 961-8173

NPI assigned

Apr 12, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Raymond J. Perea

Title

President

Phone

(760) 887-1632

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1428796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1962898437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12350 INDIAN RIVER DR",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923086771",
            "telephone_number": "760-887-1632",
            "fax_number": "760-961-8173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12350 INDIAN RIVER DR",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923086771",
            "telephone_number": "760-887-1632",
            "fax_number": "760-961-8173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL RECOVERY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-12",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "PEREA",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-887-1632",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "360103AN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Innocence Rencher
• Elena Marie Rendon
• Lavonne Renno, LPCC8744
• John Paul Renteria
• Emily Jean Reul, DPT
• Ashley Reyes
• Eric Efren Reyes
• Julian Reyes
• Mikailyn Reyes
• Noemi Reyes

• Substance Abuse Rehabilitation Facility in Apple Valley, CA
• Providers in Apple Valley, 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 Jun 26, 2015; 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.