Organization
REVIVE RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRYL YORK RN (OWNER)
(909) 241-7555
Entity
Organization
Contact information
Practice address
7894 MURPHY RD, MELBA, ID 83641-5167
(909) 241-7555
Mailing address
2432 W BAY POINTE AVE, NAMPA, ID 83651-5038
(909) 241-7555
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
08/02/2022
Last updated
08/02/2022
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