# REVIVE RECOVERY NM

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

## Provider details

- **NPI number:** 1700630050
- **Authorized official:** JOSEPH G VIGIL LSAA (OWNER)
- **Authorized official phone:** (505) 785-4737

## Contact information

- **Practice address:** 2325 SAN PEDRO DR NE STE 2A, ALBUQUERQUE, NM 87110-4121
- **Practice address phone:** (505) 785-4737
- **Mailing address:** 12309 CONEJO RD NE, ALBUQUERQUE, NM 87123-1517
- **Mailing address phone:** (505) 785-4737

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |

## Other

- **Enumeration date:** 04/15/2024
- **Last updated:** 04/15/2024