| Revive Wellness Llc | |
|
81 Wisteria Dr Naugatuck CT 06770-5235 | |
| (203) 501-4624 | |
| Not Available |
| Full Name | Revive Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 81 Wisteria Dr, Naugatuck, Connecticut |
| Authorized Official Name and Position | Danielle Moraes (DIRECTOR) |
| Authorized Official Contact | 2035014624 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Wellness Llc 81 Wisteria Dr Naugatuck CT 06770-5235 Ph: (203) 501-4624 | Revive Wellness Llc 81 Wisteria Dr Naugatuck CT 06770-5235 Ph: (203) 501-4624 |
| NPI Number | 1235884073 |
|---|---|
| Provider Enumeration Date | 02/21/2022 |
| Last Update Date | 02/21/2022 |
| Certification Date | 02/21/2022 |
| Medicare PECOS PAC ID | 2668851064 |
|---|---|
| Medicare Enrollment ID | O20220615000796 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235884073 | NPI | - | NPPES |
| Provider Name | Jacqueline Marisol Murillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962179275 PECOS PAC ID: 6103224530 Enrollment ID: I20211014002721 |
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