REVIVE COUNSELING AND WELLNESS (NPI# 1619509080) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619509080 |
| Entity Type | Organization |
| Organization Name | REVIVE COUNSELING AND WELLNESS |
| Practice Address |
317 S Eddy St South Bend IN 46617-3201 |
| Practice Telephone | 2193794362 |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2020-02-04 |
| Authorized Official Name | APRIL ROWE (OWNER) |
| Authorized Official Telephone | 2193794362 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | REVIVE COUNSELING AND WELLNESS SERVICES LLC | 284 Racebrook Road Suite 200, Orange, CT 06477 |
| Street Address |
317 S EDDY ST |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46617-3201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740731116 | Jack Mcintyre Kimmell | Specialist/Technologist | 1526 East Lasalle, South Bend, IN 46617 | 2016-10-20 |
| 1023429115 | Morning View Assisted Living LLC | Assisted Living Facility | 475 N. Niles Avenue, South Bend, IN 46617 | 2014-05-12 |
| 1265861231 | Rebecca Busenbark | Physical Therapist | 401 E Colfax Ave Ste 102, South Bend, IN 46617 | 2013-11-11 |
| 1962709071 | Doreen Danice Huddleston | Social Worker | 928 East Wayne St, Suit C, South Bend, IN 46617 | 2011-02-25 |
| 1487981734 | Mary Cecilia Roemer | Marriage & Family Therapist | 616 E. Colfax Ave, South Bend, IN 46617 | 2009-11-06 |
| 1225264054 | Sridhar Meda | Dentist | 1005 East Lasalle Ave, South Bend, IN 46617 | 2009-06-08 |
| 1063673531 | Madeline Christina Watkins | Counselor | 616 E Colfax, South Bend, IN 46617 | 2008-06-18 |
| 1437366481 | Michael Reed Johns | Dentist | 103 South Eddy Street, South Bend, IN 46617 | 2007-05-17 |
| 1194937680 | Sarah Elizabeth Redman | Specialist/Technologist | 53880 Carmichael Dr., South Bend, IN 46617 | 2007-05-04 |
| 1124241211 | Trixy Franke | Family Medicine | 837 E. Cedar St., Ste 100, South Bend, IN 46617 | 2007-04-10 |
| Find all providers in zip 46617 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1437421435 | Anthony L Berardi, Phd PC | Clinic/Center | 300 S Saint Louis Blvd, Suite 202, South Bend, IN 46617-3043 | 2012-02-07 |
| 1750411872 | Madison Center, Inc. | Clinic/Center | 403 E Madison St, South Bend, IN 46617-2322 | 2007-03-07 |
| 1376691154 | Madison Center, Inc. | Clinic/Center | 403 E Madison St, South Bend, IN 46617-2322 | 2007-01-08 |
| 1174671952 | Madison Center, Inc. | Clinic/Center | 403 E Madison St, South Bend, IN 46617-2322 | 2007-01-08 |
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| Find all providers with the same taxonomy | ||||
| City | SOUTH BEND |
| Zip Code | 46617 |
Please comment or provide details below to improve the information on REVIVE COUNSELING AND WELLNESS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.