Organization
ORANGE COUNTY REVIVE SERVICES, INC.
Active
Parent organization
ORANGE COUNTY REVIVE SERVICES, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
ORANGE COUNTY REVIVE SERVICES, INC.
Authorized official
TYLER MICHAELIS (CEO)
(949) 606-4681
Entity
Organization
Contact information
Practice address
23726 BIRTCHER DR, LAKE FOREST, CA 92630-1771
(949) 606-4681
Mailing address
23726 BIRTCHER DR, LAKE FOREST, CA 92630-1771
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/14/2023
Last updated
02/14/2023
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