REVIVE DETOX NPI 1639561566

NPI Information

REVIVE DETOX is a substance abuse rehabilitation facility in Los Angeles, CA. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. REVIVE DETOX NPI is 1639561566. The provider is registered as an organization entity type.

The provider's business location address is:

360 N VISTA ST
LOS ANGELES, CA
ZIP 90036-739
Phone: (818) 462-3824

The provider's authorized official is Matthew Conley .
The authorized official title is Program Director and has the following contact phone number (818) 462-3824.

The enumeration date for this NPI number is 3/2/2015 and was last updated on 3/2/2015.

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:

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