LIFE REVIVAL LLC
NPI 1023701067
Community/Behavioral Health in Philadelphia, PA

Q: What is Life Revival LLC's NPI number?

The NPI number for Life Revival LLC is 1023701067. It was assigned to this organization in the NPPES registry on May 26, 2023. The provider is also known as Life Revival, LLC.

Q: What is Life Revival LLC's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Q: When was this NPI record last updated?

The NPPES record for Life Revival LLC was last updated on February 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 26, 2023

6404 ROOSEVELT BLVD, PHILADELPHIA, PA 19149(267) 577-7747 Get Directions Write a Review

NPPES record last updated: February 11, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 11, 2025, May 26, 2023 (2 updates tracked since 2023).

On this page

About Life Revival Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIFE REVIVAL LLC (NPI 1023701067) is a healthcare organization registered as a community/behavioral health in Philadelphia, Pennsylvania and active in the NPI registry since May 2023. The organization lists Daniel Lee, Director, as its authorized official.

NPPES Registry Identity

NPI1023701067

Entity TypeOrganization

Primary Taxonomy251S00000X

Legal Business NameLIFE REVIVAL LLC

Location Address6404 ROOSEVELT BLVDPhiladelphia, PA 19149-2943

Mailing Address6404 Roosevelt BlvdPhiladelphia, PA 19149-2943

Phone(267) 577-7747

Organization SubpartNo

Authorized OfficialDaniel LeeDirector · (267) 259-4558

Enumeration DateMay 26, 2023

Last NPPES UpdateFebruary 11, 20252 updates tracked since enumeration

NPPES CertifiedFebruary 11, 2025

✔ NPI 1023701067 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyCommunity/Behavioral HealthAgencies

Taxonomy Code251S00000X

Definition

A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X

Also ListedPsychologist · CounselingTaxonomy 103TC1900X

Also ListedPsychologist · FamilyTaxonomy 103TF0000X

Also ListedPsychologist · PsychoanalysisTaxonomy 103TP0814X

Also ListedPsychologist · Group PsychotherapyTaxonomy 103TP2701X

Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X

Also ListedPsychiatry & Neurology · Child & Adolescent PsychiatryTaxonomy 2084P0804X

Also ListedPsychiatry & Neurology · Geriatric PsychiatryTaxonomy 2084P0805X

Also ListedCase ManagementTaxonomy 251B00000X

Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X

Also ListedClinic/Center · Adult Mental HealthTaxonomy 261QM0850X

Also ListedClinic/Center · Adolescent and Children Mental HealthTaxonomy 261QM0855X

Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X

6404 ROOSEVELT BLVD, Philadelphia, PA 19149

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Other Names 1

Other NameLife Revival, Llc

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Life Revival Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Life Revival LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Kathleen Neil, MSN, PMHNP-BC

Nurse Practitioner

NPI 1861247876

6404 ROOSEVELT BLVD
Philadelphia, PA 19149

(215) 660-7990

✔ PECOS✔ Accepts MedicareSame address

Abayomi Ige, M.D.

Psychiatry

NPI 1184620130

1315 WINDRIM AVE
Philadelphia, PA 19141

(215) 455-3900

✔ PECOS✔ Accepts Medicare4.0 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Life Revival LLC's NPI number?

The NPI number for Life Revival LLC is 1023701067. It was assigned to this organization in the NPPES registry on May 26, 2023. The provider is also known as Life Revival, LLC.

Where is Life Revival LLC located?

Life Revival LLC is located at 6404 Roosevelt Blvd, Philadelphia, PA 19149. The listed phone number is (267) 577-7747.

What is Life Revival LLC's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Is Life Revival LLC enrolled in Medicare?

Yes. Life Revival LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Life Revival LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Life Revival LLC, in Nurse Practitioner and Psychiatry. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Life Revival LLC was last updated on February 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.