| Organization Name: | REVIVE INC |
| NPI Number: | 1063646479 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAN RUTT (DIRECTOR) |
| Mailing Address: | 835 S Burlington Ave Ste. 115 Hastings |
| State: | NE US |
| Postal Code: | 689016960 |
| Phone Number: | 4024622066 |
| Fax Number: | 4024622045 |
| NPI Enumeration Date: | 05/13/2009 |
| NPI Last Update Date: | 05/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | SATC171 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |