Organization
REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY BROWN NP (CEO)
(260) 298-8297
Entity
Organization
Contact information
Practice address
402 E MAIN ST, FORT WAYNE, IN 46802-1910
(260) 298-8297
(260) 387-6154
Mailing address
402 E MAIN ST, FORT WAYNE, IN 46802-1910
(260) 298-8297
(260) 387-6154
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
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