Organization
REVIVE RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN KAY THEISSEN (BOARD OF DIR - SECRETARY/TREASURER)
(507) 456-1633
Entity
Organization
Contact information
Practice address
18990 WESTBAY LN, WATERVILLE, MN 56096-4138
(507) 456-1633
Mailing address
18990 WESTBAY LN, WATERVILLE, MN 56096-4138
(507) 456-1633
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/11/2026
Last updated
04/11/2026
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