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General NPI Number Information
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NPI Number | 1932053105
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Entity Type | Organization
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Legal Business Name | REVIVE RENO LLC
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 3101 PLUMAS ST
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City | RENO
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State | NV
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Zip | 89509-4515
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Country | US
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Telephone | 775-828-5600
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Fax | 775-437-5336
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Provider Business Mailing Address
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Address Line | 9410 PROTOTYPE DR STE 7-9
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City | RENO
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State | NV
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Zip | 89521-5902
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Country | US
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Telephone | 775-828-5600
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Fax | 775-437-5336
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Authorized Official
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Title or Position | AR DIRECTOR
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Name | SHARON AUSTIN-MOFFETT
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Credential |
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Telephone | 775-828-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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