REVIVE 180 LLC NPI 1568197556

NPI Information

  • NPI: 1568197556
  • Provider Name: REVIVE 180 LLC
  • Classification: Counselor - 101YP2500X
  • Specialization: Professional
  • Entity Type: Organization
  • Address: 10071 CRESCENT RD
    POTOSI, MO
    ZIP 63664
  • Phone: (573) 438-9800

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NPI Details

REVIVE 180 LLC is a professional counselor in Potosi, MO. REVIVE 180 LLC NPI is 1568197556. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

10071 CRESCENT RD
POTOSI, MO
ZIP 63664-040
Phone: (573) 438-9800
Fax: (573) 240-9916

The provider's authorized official is Christy L Pashia .
The authorized official title is Professional Counselor/owner and has the following contact phone number (573) 438-9800.

The enumeration date for this NPI number is 7/22/2022 and was last updated on 12/11/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YP2500XCounselorProfessionalYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1490084654MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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