Healthcare Provider Details

I. General information

NPI: 1932053105
Provider Name (Legal Business Name): REVIVE RENO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 PLUMAS ST
RENO NV
89509-4515
US

IV. Provider business mailing address

9410 PROTOTYPE DR STE 7-9
RENO NV
89521-5902
US

V. Phone/Fax

Practice location:
  • Phone: 775-828-5600
  • Fax: 775-437-5336
Mailing address:
  • Phone: 775-828-5600
  • Fax: 775-437-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARON AUSTIN-MOFFETT
Title or Position: AR DIRECTOR
Credential:
Phone: 775-828-5600