MEDICARE: HOOVER'S REVIVED HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1053268896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOVER'S REVIVED HEALTH LLC

Provider Business Mailing Address
First Line	:	7701 LEMMON AVE STE 260
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-3003
Country	:	US
Telephone Number	:	769-241-0554
Fax Number	:

Provider Business Practice Location Address
First Line	:	7701 LEMMON AVE STE 260
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-3003
Country	:	US
Telephone Number	:	769-241-0554
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	NIASHA HOOVER
Credential	:
Telephone Number	:	469-719-2262

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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