Organization
REVIVE MINISTRIES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEROME A TOMLIAN LCSW, LCADC (PROGRAM DIRECTOR)
(859) 576-8279
Entity
Organization
Contact information
Practice address
185 ELM TREE LN, LEXINGTON, KY 40507
(859) 469-9023
(859) 881-0045
Mailing address
185 ELM TREE LN, LEXINGTON, KY 40507-1924
(859) 576-8279
(859) 881-0045
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
710052080
—
KY
01
—
810626
BHSO
KY
Enumeration date
04/17/2018
Last updated
10/02/2018
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