Organization
REVIVAL HOUSING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE TAN (CFO)
(651) 338-8512
Entity
Organization
Contact information
Practice address
140 BELVIDERE ST W, WEST ST PAUL, MN 55118-5717
(952) 239-6790
Mailing address
438 DALY ST, SAINT PAUL, MN 55102-3550
(952) 239-6790
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/24/2026
Last updated
02/24/2026
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