Organization
ORANGE COUNTY REVIVE SERVICES, INC.
Active
Other names
OC Revive
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER MICHAELIS (CEO)
(949) 606-4681
Entity
Organization
Contact information
Practice address
24432 MUIRLANDS BLVD STE 221, LAKE FOREST, CA 92630-3951
(949) 510-3358
Mailing address
24432 MUIRLANDS BLVD STE 221, LAKE FOREST, CA 92630-3951
(949) 510-3358
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/30/2018
Last updated
09/30/2019
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