NPI Code Detail JSON Logo

1063316099 NPI number — REVIVE HOPE & WELLNESS LLC

NPI Number: 1063316099
Health Care Provider/Practitioner: REVIVE HOPE & WELLNESS LLC

Information about “1063316099” NPI (REVIVE HOPE & WELLNESS LLC) exists in 1063316099 in HTML format HTML  |  1063316099 in plain Text format TXT  |  1063316099 in PDF (Portable Document Format) PDF  |  1063316099 in an XML format XML  formats.

NPI Number : 1063316099 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063316099",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "REVIVE HOPE & WELLNESS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "544 STRAITS TPKE STE 3",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WATERTOWN",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06795-3340",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "101 PIERPOINT ROAD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATERBURY",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06705",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-508-5069",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/05/2026",
    "LastUpdateDate": "10/05/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WHITE",
    "AuthorizedOfficialFirstName": "VENESA",
    "AuthorizedOfficialMiddleName": "SHANIQUE",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "203-508-5069",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "NULL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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