Organization
REVIVE MINISTRIES INC
Active
Other names
Revive Life House Outpatient Center
Organization subpart
No
Provider details
NPI number
Authorized official
TODD JOHNS (CEO)
(859) 354-9841
Entity
Organization
Contact information
Practice address
800 S. MAIN STREET, SUITE C., NICHOLASVILLE, KY 40356-1868
(859) 241-5174
(859) 305-6004
Mailing address
800 S. MAIN STREET, SUITE C., NICHOLASVILLE, KY 40356-1868
(859) 241-5174
(859) 305-6004
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100737830
—
KY
Enumeration date
03/17/2021
Last updated
03/26/2026
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