Organization
REVIVAL RECOVERY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND J. PEREA (PRESIDENT)
(760) 887-1632
Entity
Organization
Contact information
Practice address
12350 INDIAN RIVER DR, APPLE VALLEY, CA 92308-6771
(760) 887-1632
(760) 961-8173
Mailing address
12350 INDIAN RIVER DR, APPLE VALLEY, CA 92308-6771
(760) 887-1632
(760) 961-8173
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
360103AN
CA
Other
Enumeration date
04/12/2015
Last updated
06/26/2015
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