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Organization

REVIVE WELLNESS GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KEVORK SHAHINIAN (CFO)
(818) 634-7091
Entity
Organization

Contact information

Practice address
5401 VANALDEN AVE, TARZANA, CA 91356-3129
(818) 634-7091
Mailing address
9528 TOPANGA CANYON BLVD, CHATSWORTH, CA 91311-4011

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
324500000X
Substance Abuse Rehabilitation Facility
Primary

Other

Enumeration date
03/19/2024
Last updated
10/04/2024
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