| Revive Behavioral Health And Wellness Llc | |
|
215 N Wheeler Ave Grand Island NE 68801-5961 | |
| (308) 391-2280 | |
| (308) 832-4803 |
| Full Name | Revive Behavioral Health And Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 215 N Wheeler Ave, Grand Island, Nebraska |
| Authorized Official Name and Position | Angela Lyon (OWNER) |
| Authorized Official Contact | 3088504330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Behavioral Health And Wellness Llc 215 N Wheeler Ave Grand Island NE 68801-5961 Ph: (308) 391-2280 | Revive Behavioral Health And Wellness Llc 215 N Wheeler Ave Grand Island NE 68801-5961 Ph: (308) 391-2280 |
| NPI Number | 1548926801 |
|---|---|
| Provider Enumeration Date | 11/11/2021 |
| Last Update Date | 09/14/2022 |
| Certification Date | 09/14/2022 |
| Medicare PECOS PAC ID | 6305237918 |
|---|---|
| Medicare Enrollment ID | O20211215001055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548926801 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Angela Lyon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063844645 PECOS PAC ID: 4284907619 Enrollment ID: I20170907001276 |
| Provider Name | Sara Urwiller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174067599 PECOS PAC ID: 2365803699 Enrollment ID: I20230802001806 |
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