| Revive Therapy And Wellness Llc | |
|
117 Minarette Dr Sw Poplar Grove IL 61065-8538 | |
| (815) 575-9887 | |
| Not Available |
| Full Name | Revive Therapy And Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 117 Minarette Dr Sw, Poplar Grove, Illinois |
| Authorized Official Name and Position | Shelli L Pollard (OWNER) |
| Authorized Official Contact | 8155759887 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Therapy And Wellness Llc 117 Minarette Dr Sw Poplar Grove IL 61065-8538 Ph: (815) 575-9887 | Revive Therapy And Wellness Llc 117 Minarette Dr Sw Poplar Grove IL 61065-8538 Ph: (815) 575-9887 |
| NPI Number | 1780446476 |
|---|---|
| Provider Enumeration Date | 01/29/2024 |
| Last Update Date | 02/28/2024 |
| Certification Date | 02/28/2024 |
| Medicare PECOS PAC ID | 7618312711 |
|---|---|
| Medicare Enrollment ID | O20240228003395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780446476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shelli Pollard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053786269 PECOS PAC ID: 2567724479 Enrollment ID: I20180313000029 |
Powerhouse Aba, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 213 Tamarack Hollow St Sw, Poplar Grove, IL 61065 Phone: 630-283-2962 |