Organization
REVIVAL MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER MICHAELIS (MANAGING MEMBER)
(949) 606-4681
Entity
Organization
Contact information
Practice address
16252 MAGELLAN LN, HUNTINGTON BEACH, CA 92647-3525
(949) 776-9476
Mailing address
16252 MAGELLAN LN, HUNTINGTON BEACH, CA 92647-3525
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/10/2024
Last updated
01/10/2024
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