REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC – NPI #1699617860
Clinic/Center

REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC is an AHC clinic located in FORT WAYNE, IN. NPPES recently assigned the NPI number 1699617860 to REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC on April 07, 2026. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QM0801X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Mental Health (Including Community Mental Health Center)

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC below.

NPI Profile for
REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC

NPI Number
1699617860
Enumeration Date

(about 2 months ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC
Primary location
402 E MAIN ST
FORT WAYNE, IN 46802-1910
Phone: (260) 298-8297 Fax: (260) 387-6154
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
ASHLEY BROWN
CEO
Phone: (260) 298-8297
Updated
Certification Date
Apr 07, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QM0801X
- Clinic/Center / Mental Health (Including Community Mental Health Center) (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.