Healthcare Provider Details

I. General information

NPI: 1912728536
Provider Name (Legal Business Name): REVIVE AABIZIISHIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 BIA RD 8
BELCOURT ND
58316
US

IV. Provider business mailing address

PO BOX 393
BELCOURT ND
58316-0393
US

V. Phone/Fax

Practice location:
  • Phone: 701-953-7076
  • Fax: 701-953-7076
Mailing address:
  • Phone: 701-953-7076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: JAMES MURVIL LINDGREN
Title or Position: CARE COORDINATOR/ PEERS SUPPORT
Credential:
Phone: 701-953-7076