Provider Demographics
NPI:1912899204
Name:REVIVEPATH RECOVERY
Entity type:Organization
Organization Name:REVIVEPATH RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOU
Authorized Official - Prefix:
Authorized Official - First Name:WHALIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-444-9292
Mailing Address - Street 1:2920 N 24TH AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5959
Mailing Address - Country:US
Mailing Address - Phone:702-444-9292
Mailing Address - Fax:
Practice Address - Street 1:2920 N 24TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5959
Practice Address - Country:US
Practice Address - Phone:702-444-9292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health