Provider Demographics
NPI:1225753858
Name:REVIVE THERAPY SERVICES
Entity Type:Organization
Organization Name:REVIVE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:267-600-8142
Mailing Address - Street 1:4511 KINGSESSING AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3712
Mailing Address - Country:US
Mailing Address - Phone:267-600-8142
Mailing Address - Fax:
Practice Address - Street 1:4305 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5382
Practice Address - Country:US
Practice Address - Phone:267-600-8142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)