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General NPI Number Information
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NPI Number | 1982547295
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Entity Type | Organization
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Legal Business Name | REVIVE RECOVERY
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Dates
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Enumeration Date | 04/11/2026
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Last Update Date | 04/11/2026
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Provider Practice Location Address
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Address Line | 18990 WESTBAY LN
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City | WATERVILLE
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State | MN
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Zip | 56096-4138
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Country | US
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Telephone | 507-456-1633
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Fax |
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Provider Business Mailing Address
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Address Line | 18990 WESTBAY LN
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City | WATERVILLE
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State | MN
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Zip | 56096-4138
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Country | US
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Telephone | 507-456-1633
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Fax |
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Authorized Official
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Title or Position | BOARD OF DIR - SECRETARY/TREASURER
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Name | KAREN KAY THEISSEN
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Credential |
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Telephone | 507-456-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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