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General NPI Number Information
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NPI Number | 1659221315
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Entity Type | Organization
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Legal Business Name | REVIVE AGAIN THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 231 W CORNERVIEW ST
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City | GONZALES
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State | LA
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Zip | 70737-2841
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Country | US
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Telephone | 985-232-8449
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Fax |
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Provider Business Mailing Address
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Address Line | 265 HOLLOW RIDGE AVE
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City | GONZALES
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State | LA
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Zip | 70737-7545
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Country | US
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Telephone | 985-232-8449
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Fax | 985-232-8449
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Authorized Official
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Title or Position | OWNER
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Name | MIYOKIA CARTER
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Credential | CARTER
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Telephone | 985-232-8449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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