| Revive Life House Outpatient Center | |
|
800 S. Main Street Suite C. Nicholasville KY 40356-1868 | |
| (859) 241-5174 | |
| (859) 305-6004 |
| Full Name | Revive Life House Outpatient Center |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 800 S. Main Street, 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 Life House Outpatient Center 800 S. Main Street Suite C. Nicholasville KY 40356-1868 Ph: (859) 241-5174 | Revive Life House Outpatient Center 800 S. Main Street Suite C. Nicholasville KY 40356-1868 Ph: (859) 241-5174 |
| NPI Number | 1891370185 |
|---|---|
| Provider Enumeration Date | 03/17/2021 |
| Last Update Date | 11/18/2022 |
| Certification Date | 11/18/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891370185 | NPI | - | NPPES |
| 7100737830 | Medicaid | KY |
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