Organization
REVOLVE RECOVERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN AUSTIN (COMPLIANCE OFFICER)
(818) 915-5668
Entity
Organization
Contact information
Practice address
3101 WASHINGTON BLVD, MARINA DEL REY, CA 90292-5571
(323) 253-3047
Mailing address
1732 AVIATION BLVD STE 317, REDONDO BEACH, CA 90278-2810
(323) 253-3047
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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