Provider Demographics
NPI:1629861224
Name:REVIVE THERAPEUTIC SERVICES INC
Entity type:Organization
Organization Name:REVIVE THERAPEUTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AKOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-648-7172
Mailing Address - Street 1:PO BOX 3085
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-0585
Mailing Address - Country:US
Mailing Address - Phone:401-648-7172
Mailing Address - Fax:
Practice Address - Street 1:845 N MAIN ST STE L1B
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5775
Practice Address - Country:US
Practice Address - Phone:401-648-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management