Organization
VIDI REVIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALAIH RADNEY (OWNER)
(917) 545-1840
Entity
Organization
Contact information
Practice address
6895 E CAMELBACK RD UNIT 1024, SCOTTSDALE, AZ 85251-2475
(917) 545-1840
Mailing address
6895 E CAMELBACK RD UNIT 1024, SCOTTSDALE, AZ 85251-2475
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/15/2020
Last updated
05/15/2020
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