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Organization
REVIVE MINISTRIES INC
Active
Organization
REVIVE MINISTRIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD JOHNS (CEO)
(859) 354-9841
Entity
Organization
Contact information
Practice address
111 COCONUT GROVE DRIVE, NICHOLASVILLE, KY 40356-2321
(859) 881-4505
(859) 241-1483
Mailing address
800 S MAIN STREET, SUITE C, NICHOLASVILLE, KY 40356-1868
(859) 241-5174
(859) 305-6004
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100541540
MEDICAID GROUP
KY
05
—
7100649290
—
KY
01
—
810626
BHSO
KY
Enumeration date
04/16/2018
Last updated
11/23/2022
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