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Organization
REVIVE MINISTRIES INC
Active
Organization
REVIVE MINISTRIES INC
Active
Other names
Revive Life House Outpatient Center
Organization subpart
No
Provider details
NPI number
Authorized official
TODD JOHNS (CEO)
(859) 354-9841
Entity
Organization
Contact information
Practice address
800 S. MAIN STREET, SUITE C., NICHOLASVILLE, KY 40356-1868
(859) 241-5174
(859) 305-6004
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
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100737830
—
KY
Enumeration date
03/17/2021
Last updated
03/26/2026
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