| Revival Housing Llc | |
|
140 Belvidere St W West St Paul MN 55118-5717 | |
| (952) 239-6790 | |
| Not Available |
| Full Name | Revival Housing Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 140 Belvidere St W, West St Paul, Minnesota |
| Authorized Official Name and Position | Lawrence Tan (CFO) |
| Authorized Official Contact | 6513388512 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revival Housing Llc 438 Daly St Saint Paul MN 55102-3550 Ph: (952) 239-6790 | Revival Housing Llc 140 Belvidere St W West St Paul MN 55118-5717 Ph: (952) 239-6790 |
| NPI Number | 1841144912 |
|---|---|
| Provider Enumeration Date | 02/24/2026 |
| Last Update Date | 02/24/2026 |
| Certification Date | 02/24/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841144912 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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