Organization
REVIVE COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JLYNN DARAE HARTZELL (CEO)
(402) 320-3057
Entity
Organization
Contact information
Practice address
18930 GROVER ST, OMAHA, NE 68130-6089
(402) 320-3057
Mailing address
18930 GROVER ST, OMAHA, NE 68130-6089
(402) 320-3057
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/25/2024
Last updated
07/12/2025
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