REVIVAL WELLNESS LLC – NPI #1790653533
Family Medicine

The NUCC recommends this code not be used. Choose a more appropriate code.

Health Care Provider Taxonomy Code for Family Medicine

REVIVAL WELLNESS LLC is a provider located in MORRIS, MN. NPPES has assigned the NPI number 1790653533 to REVIVAL WELLNESS LLC on October 24, 2025. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 207QA0505X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine, specializing in Adult Medicine

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 REVIVAL WELLNESS LLC below.

NPI Profile for
REVIVAL WELLNESS LLC

NPI Number
1790653533
Enumeration Date

(about 7 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
REVIVAL WELLNESS LLC
Primary location
511 OREGON AVE PDT SUITE B3
MORRIS, MN 56267
Phone: (320) 491-0594 Fax: (320) 491-0594
Mailing address
511 OREGON AVE
MORRIS, MN 56267-3712
Phone: (320) 491-0594 Fax: (320) 491-0594
Organization Subpart
No
Authorized Official
NATHAN MALEK
CEO
Phone: (320) 491-0594
Updated
Certification Date
Oct 07, 2025

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
207QA0505X
- Family Medicine / Adult Medicine (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.