Provider Demographics
NPI:1912728536
Name:REVIVE AABIZIISHIN LLC
Entity type:Organization
Organization Name:REVIVE AABIZIISHIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR/ PEERS SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MURVIL
Authorized Official - Last Name:LINDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-953-7076
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0393
Mailing Address - Country:US
Mailing Address - Phone:701-953-7076
Mailing Address - Fax:
Practice Address - Street 1:4215 BIA RD 8
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-953-7076
Practice Address - Fax:701-953-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty