Provider Demographics
NPI:1811518723
Name:REVIVE COMMUNITY MENTAL HEALTH CLINICS, LLC
Entity type:Organization
Organization Name:REVIVE COMMUNITY MENTAL HEALTH CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ABELARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-779-3738
Mailing Address - Street 1:5353 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2269
Mailing Address - Country:US
Mailing Address - Phone:305-649-4777
Mailing Address - Fax:305-649-2634
Practice Address - Street 1:5353 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2269
Practice Address - Country:US
Practice Address - Phone:305-649-4777
Practice Address - Fax:305-649-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health