# REVIVE WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205583630
- **Authorized official:** RACHEL TAYLOR (OWNER/MANAGER)
- **Authorized official phone:** (985) 351-1673

## Contact information

- **Practice address:** 704 POINCIANA AVE, MAMOU, LA 70554-2224
- **Practice address phone:** (337) 468-4038
- **Mailing address:** PO BOX 821, CARENCRO, LA 70520-0821

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/05/2022
- **Last updated:** 03/05/2022