Healthcare Provider Details

I. General information

NPI: 1073428470
Provider Name (Legal Business Name): REVIVING PASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 JIMMY PHILLIPS BLVD
ANGLETON TX
77515-7407
US

IV. Provider business mailing address

1380 JIMMY PHILLIPS BLVD
ANGLETON TX
77515-7407
US

V. Phone/Fax

Practice location:
  • Phone: 281-747-5700
  • Fax:
Mailing address:
  • Phone: 281-747-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA TO-TRINH TRAN
Title or Position: OPERATIONAL MANAGER
Credential: RN
Phone: 832-858-2450