Healthcare Provider Details

I. General information

NPI: 1023940772
Provider Name (Legal Business Name): REVIVE SV OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 STONE VALLEY DR
RENO NV
89523-1203
US

IV. Provider business mailing address

9410 PROTOTYPE DR STE 7
RENO NV
89521-5903
US

V. Phone/Fax

Practice location:
  • Phone: 775-746-2200
  • Fax:
Mailing address:
  • Phone: 775-746-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY GRAY
Title or Position: CEO
Credential:
Phone: 518-852-3255