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Organization
KOANN THERAPEUTIC SERVICES INC
Active
Organization
KOANN THERAPEUTIC SERVICES INC
Active
Other names
Revive Therapeutic Services
Organization subpart
No
Provider details
NPI number
Authorized official
AKOS ANTWI (PROVIDER/CEO)
(401) 648-7172
Entity
Organization
Contact information
Practice address
845 N MAIN ST, PROVIDENCE, RI 02904-5700
(401) 648-7172
(401) 648-0161
Mailing address
PO BOX 3085, PAWTUCKET, RI 02861-0585
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
—
NULL
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
—
—
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
—
NULL
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
—
—
251B00000X
Case Management Agency
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/05/2021
Last updated
01/12/2026
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