Organization
REVIVE RECOVERY NM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH G VIGIL LSAA (OWNER)
(505) 785-4737
Entity
Organization
Contact information
Practice address
2325 SAN PEDRO DR NE STE 2A, ALBUQUERQUE, NM 87110-4121
(505) 785-4737
Mailing address
12309 CONEJO RD NE, ALBUQUERQUE, NM 87123-1517
(505) 785-4737
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
04/15/2024
Last updated
04/15/2024
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