Healthcare Provider Details

I. General information

NPI: 1437053733
Provider Name (Legal Business Name): REVIVAL HEALTH MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 VREELAND DR STE 2
SKILLMAN NJ
08558-2637
US

IV. Provider business mailing address

30 VREELAND DR STE 2
SKILLMAN NJ
08558-2637
US

V. Phone/Fax

Practice location:
  • Phone: 646-529-4655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAYLA ROJAS
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 206-898-5432