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General NPI Number Information
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NPI Number | 1063909067
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Entity Type | Organization
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Legal Business Name | REVIVE MINISTRIES INC
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 111 COCONUT GROVE DRIVE
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-2321
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Country | US
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Telephone | 859-881-4505
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Fax | 859-241-1483
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Provider Business Mailing Address
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Address Line | 800 S MAIN STREET SUITE C
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1868
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Country | US
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Telephone | 859-241-5174
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Fax | 859-305-6004
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Authorized Official
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Title or Position | CEO
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Name | TODD JOHNS
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Credential |
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Telephone | 859-354-9841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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