| Revive Mental Health Center Inc | |
|
18325 Sherman Way Ste B Reseda CA 91335-4425 | |
| (818) 217-1212 | |
| Not Available |
| Full Name | Revive Mental Health Center Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 18325 Sherman Way Ste B, Reseda, California |
| Authorized Official Name and Position | Tatevik Grigoryan (OWNER) |
| Authorized Official Contact | 8182171212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Mental Health Center Inc Po Box 3151 Granada Hills CA 91394-0151 Ph: (818) 217-1212 | Revive Mental Health Center Inc 18325 Sherman Way Ste B Reseda CA 91335-4425 Ph: (818) 217-1212 |
| NPI Number | 1619787504 |
|---|---|
| Provider Enumeration Date | 01/13/2025 |
| Last Update Date | 01/13/2025 |
| Certification Date | 01/12/2025 |
| Medicare PECOS PAC ID | 0446773998 |
|---|---|
| Medicare Enrollment ID | O20250326000621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619787504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Tatevik Grigoryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477302305 PECOS PAC ID: 3173046620 Enrollment ID: I20250331003111 |
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