| Revive Ministries Inc | |
|
111 Coconut Grove Drive Nicholasville KY 40356-2321 | |
| (859) 881-4505 | |
| (859) 241-1483 |
| Full Name | Revive Ministries Inc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 111 Coconut Grove Drive, Nicholasville, Kentucky |
| Authorized Official Name and Position | Todd Johns (CEO) |
| Authorized Official Contact | 8593549841 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Ministries Inc 800 S Main Street Suite C Nicholasville KY 40356-1868 Ph: (859) 241-5174 | Revive Ministries Inc 111 Coconut Grove Drive Nicholasville KY 40356-2321 Ph: (859) 881-4505 |
| NPI Number | 1063909067 |
|---|---|
| Provider Enumeration Date | 04/16/2018 |
| Last Update Date | 11/23/2022 |
| Certification Date | 11/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063909067 | NPI | - | NPPES |
| 7100649290 | Medicaid | KY | |
| 7100541540 | Other | KY | MEDICAID GROUP |
| 810626 | Other | KY | BHSO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Secondary |
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