| Revive Premier Treatment Center | |
|
13111 Ventura Blvd Studio City CA 91604-2218 | |
| (559) 201-3337 | |
| Not Available |
| Full Name | Revive Premier Treatment Center |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 13111 Ventura Blvd, Studio City, California |
| Authorized Official Name and Position | Kristopher Frontella (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5592013337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Premier Treatment Center 13111 Ventura Blvd Studio City CA 91604-2218 Ph: (559) 201-3337 | Revive Premier Treatment Center 13111 Ventura Blvd Studio City CA 91604-2218 Ph: (559) 201-3337 |
| NPI Number | 1184354946 |
|---|---|
| Provider Enumeration Date | 06/14/2022 |
| Last Update Date | 07/11/2022 |
| Certification Date | 07/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184354946 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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