Organization
REVIVAL MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER MICHAELIS (MANAGING MEMBER)
(949) 606-4681
Entity
Organization
Contact information
Practice address
9879 HAMILTON AVE, FOUNTAIN VALLEY, CA 92708-5117
(949) 606-4681
Mailing address
9879 HAMILTON AVE, FOUNTAIN VALLEY, CA 92708-5117
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/23/2022
Last updated
01/10/2024
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