Provider Demographics
NPI:1447001003
Name:REVIVE FAMILY CARE & WELLNESS LLC
Entity type:Organization
Organization Name:REVIVE FAMILY CARE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GUISELLE
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-709-2522
Mailing Address - Street 1:3667 COUNTY ROAD 2134 STE C
Mailing Address - Street 2:
Mailing Address - City:CADDO MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:75135-6897
Mailing Address - Country:US
Mailing Address - Phone:903-751-5550
Mailing Address - Fax:
Practice Address - Street 1:3667 COUNTY ROAD 2134 STE C
Practice Address - Street 2:
Practice Address - City:CADDO MILLS
Practice Address - State:TX
Practice Address - Zip Code:75135-6897
Practice Address - Country:US
Practice Address - Phone:903-751-5550
Practice Address - Fax:833-973-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty