Life Revival Llc

LBN: Life Revival Llc
Life Revival Llc is an health care organization with primary practice located at 6404 Roosevelt Blvd , Philadelphia PA 19149-2943. The organization recently has 15 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Counseling, Behavioral Health & Social Service Providers / Family, Behavioral Health & Social Service Providers / Psychoanalysis, Behavioral Health & Social Service Providers / Group Psychotherapy, Behavioral Health & Social Service Providers / Clinical, Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry, Allopathic & Osteopathic Physicians / Geriatric Psychiatry, Agencies / Case Management, Agencies / Community/Behavioral Health, Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), Ambulatory Health Care Facilities / Adult Mental Health, Ambulatory Health Care Facilities / Adolescent and Children Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Agencies / Community/Behavioral Health is the primary health care specialty. Life Revival Llc can be contacted via phone (267) 577-7747, or through Lee, Daniel via phone (267) 259-4558.

Contact Information

Primary practice address
6404 Roosevelt Blvd Philadelphia PA 19149-2943
Phone: (267) 577-7747
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Lee, Daniel PSYD
Phone: (267) 259-4558

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Counseling 103TC1900X
Behavioral Health & Social Service Providers / Family 103TF0000X
Behavioral Health & Social Service Providers / Psychoanalysis 103TP0814X
Behavioral Health & Social Service Providers / Group Psychotherapy 103TP2701X
Behavioral Health & Social Service Providers / Clinical 1041C0700X
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X
Allopathic & Osteopathic Physicians / Geriatric Psychiatry 2084P0805X
Agencies / Case Management 251B00000X
Agencies / Community/Behavioral Health 251S00000X
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X
Ambulatory Health Care Facilities / Adolescent and Children Mental Health 261QM0855X
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X

Profile Details

NPI number 1023701067
LBN Legal business name Life Revival Llc
DBA Doing business as
Authorized official Lee, Daniel PSYD
Entity Organization
Organization subpart 1 No
Enumeration date May 26th, 2023
Last updated May 26th, 2023 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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