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REVIVE MINISTRIES INC NPI 1891370185


NPI Information

NPI: 1891370185
Provider Name: REVIVE MINISTRIES INC

Doing Business As: REVIVE LIFE HOUSE OUTPATIENT CENTER

Classification: Psychologist - 103TA0400X
Entity Type: Organization

Specialization: Addiction (Substance Use Disorder)

CLIA Number: 18D2120669

Address:
800 S. MAIN STREET
SUITE C.
NICHOLASVILLE, KY
ZIP 40356
Phone: (859) 241-5174
Get Directions

REVIVE MINISTRIES INC is an addiction (substance use disorder) psychologist in Nicholasville, KY. The provider is a psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior. REVIVE MINISTRIES INC NPI is 1891370185. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Revive Life House Outpatient Center.

The provider's business location address is:

800 S. MAIN STREET
SUITE C.
NICHOLASVILLE, KY
ZIP 40356-868
Phone: (859) 241-5174
Fax: (859) 305-6004

The provider's authorized official is Todd Johns .
The authorized official title is Ceo and has the following contact phone number (859) 354-9841.

The CLIA number assigned to this NPI record is 18D2120669 - other - sub abuse with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/17/2021 and was last updated on 11/18/2022.


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
1103T00000XPsychologistNo
2106H00000XMarriage & Family TherapistNo
3363LF0000XNurse PractitionerFamilyNo
4103TA0400XPsychologistAddiction (Substance Use Disorder)Yes

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
17100737830MEDICAIDKENTUCKY

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: 5/5/2024

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