Organization
REVIVE HEALTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY A MCDANIEL JR. (CEO)
(434) 429-5169
Entity
Organization
Contact information
Practice address
102 MILES PL, LYNCHBURG, VA 24502-4538
(434) 429-5169
Mailing address
102 MILES PL, LYNCHBURG, VA 24502
(434) 429-5169
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
VA
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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