Organization
REVIVE RECOVERY LLC
Active
Other names
MY Self Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA THOMAS (OWNER)
(239) 908-9958
Entity
Organization
Contact information
Practice address
3541 BONITA BAY BLVD STE 200, BONITA SPRINGS, FL 34134-1703
(239) 908-9958
Mailing address
3541 BONITA BAY BLVD STE 200, BONITA SPRINGS, FL 34134-1703
(239) 908-9958
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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