{
"Npi": {
"NPI": "1780536359",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RVIV WELLNESS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2125 E DESOTO WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GILBERT",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85234-3833",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-639-5534",
"MailingAddressFaxNumber": "480-520-4758",
"FirstLinePracticeLocationAddress": "2125 E DESOTO WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GILBERT",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85234-3833",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-639-5534",
"PracticeLocationAddressFaxNumber": "480-520-4758",
"EnumerationDate": "02/13/2026",
"LastUpdateDate": "02/13/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TANGUAY",
"AuthorizedOfficialFirstName": "NICOLE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS, CPC-I, LAC",
"AuthorizedOfficialTelephoneNumber": "702-913-3625",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}