Organization
REVIVE PREMIER RECOVERY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KRISTOPHER FRONTELLA (EXECUTIVE DIRECTOR)
(559) 201-3337
Entity
Organization
Contact information
Practice address
3630 POTOSI AVE, STUDIO CITY, CA 91604-4059
(559) 201-3337
Mailing address
3630 POTOSI AVE, STUDIO CITY, CA 91604-4059
(559) 201-3337
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
05/16/2023
Last updated
05/17/2023
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