| Revive Therapeutic Services | |
|
382 Thayer St Providence RI 02906-1558 | |
| (401) 648-7172 | |
| (401) 648-0161 |
| Full Name | Revive Therapeutic Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 382 Thayer St, Providence, Rhode Island |
| Authorized Official Name and Position | Akos Antwi (PROVIDER) |
| Authorized Official Contact | 4016487172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Therapeutic Services Po Box 3085 Pawtucket RI 02861-0585 Ph: () - | Revive Therapeutic Services 382 Thayer St Providence RI 02906-1558 Ph: (401) 648-7172 |
| NPI Number | 1639843303 |
|---|---|
| Provider Enumeration Date | 08/05/2021 |
| Last Update Date | 01/10/2022 |
| Certification Date | 01/10/2022 |
| Medicare PECOS PAC ID | 7113302282 |
|---|---|
| Medicare Enrollment ID | O20220912000255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639843303 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Akos Antwi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760966436 PECOS PAC ID: 9436567617 Enrollment ID: I20210428001981 |
| Provider Name | Terri Denise Miller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295492635 PECOS PAC ID: 2466823315 Enrollment ID: I20231020000395 |
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