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Organization
REVIVE BEHAVIORAL HEALTH, LLC
Active
Organization
REVIVE BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN R MOORE APRN-CNP (OWNER)
(740) 501-4836
Entity
Organization
Contact information
Practice address
206 S MULBERRY ST STE A, MOUNT VERNON, OH 43050-3331
(740) 501-4836
Mailing address
6130 SHARP RD, MOUNT VERNON, OH 43050-9477
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/09/2025
Last updated
04/10/2025
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