Provider Demographics
NPI:1063646479
Name:REVIVE INC
Entity Type:Organization
Organization Name:REVIVE INC
Other - Org Name:HORIZON RECOVERY & COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-462-2066
Mailing Address - Street 1:835 S BURLINGTON AVE
Mailing Address - Street 2:STE. 115
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6960
Mailing Address - Country:US
Mailing Address - Phone:402-462-2066
Mailing Address - Fax:402-462-2045
Practice Address - Street 1:835 S BURLINGTON AVE
Practice Address - Street 2:STE. 115
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6960
Practice Address - Country:US
Practice Address - Phone:402-462-2066
Practice Address - Fax:402-462-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NESATC171101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty