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General NPI Number Information
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NPI Number | 1912728536
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Entity Type | Organization
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Legal Business Name | REVIVE AABIZIISHIN LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 4215 BIA RD 8
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City | BELCOURT
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State | ND
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Zip | 58316
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Country | US
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Telephone | 701-953-7076
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Fax | 701-953-7076
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Provider Business Mailing Address
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Address Line | PO BOX 393
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City | BELCOURT
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State | ND
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Zip | 58316-0393
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Country | US
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Telephone | 701-953-7076
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Fax |
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Authorized Official
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Title or Position | CARE COORDINATOR/ PEERS SUPPORT
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Name | JAMES MURVIL LINDGREN
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Credential |
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Telephone | 701-953-7076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 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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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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