# KOANN THERAPEUTIC SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revive Therapeutic Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639843303
- **Authorized official:** AKOS ANTWI (PROVIDER/CEO)
- **Authorized official phone:** (401) 648-7172

## Contact information

- **Practice address:** 845 N MAIN ST, PROVIDENCE, RI 02904-5700
- **Practice address phone:** (401) 648-7172
- **Practice address fax:** (401) 648-0161
- **Mailing address:** PO BOX 3085, PAWTUCKET, RI 02861-0585

## Taxonomy

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

## Other

- **Enumeration date:** 08/05/2021
- **Last updated:** 01/12/2026