MEDICARE: REVIVE HOPE BEHAVIORAL HEALTHCARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	7X4550	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104611755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE HOPE BEHAVIORAL HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	19907 ROYCROFT LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-4003
Country	:	US
Telephone Number	:	832-264-4709
Fax Number	:

Provider Business Practice Location Address
First Line	:	19907 ROYCROFT LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-4003
Country	:	US
Telephone Number	:	832-264-4709
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	UGOCHI ODINMAH
Credential	:	NURSE PRACTITIONER
Telephone Number	:	832-264-4709

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/21/2026

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