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REVIVAL RECOVERY CENTER STAFFING LLC
NPI 1184398331
Nurse Practitioner - Family in Highland, MI

Active since August 02, 2021CLIA 23D2226623 · Waiver
208 W HIGHLAND RD STE 102, HIGHLAND, MI 48357(833) 773-8482(810) 775-0303 Get Directions Write a Review

NPPES record last updated: May 5, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 5, 2025, Sep 23, 2021, Aug 23, 2021 and 2 more (5 updates tracked since 2021).

About Revival Recovery Center Staffing Llc NPPES

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

REVIVAL RECOVERY CENTER STAFFING LLC (NPI 1184398331), doing business as Revival Recovery Center Staffing, is a healthcare organization registered as a family in Highland, Michigan and active in the NPI registry since August 2021. The organization holds a CLIA Waiver certificate valid through June 28, 2028, maintains a secondary practice location in Brighton, and lists Lisa A Perna, Owner, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1184398331
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameREVIVAL RECOVERY CENTER STAFFING LLC
Location Address208 W HIGHLAND RD STE 102Highland, MI 48357-4574
Mailing Address208 W Highland Rd Ste 102Highland, MI 48357-4574 · (833) 773-8482 · Fax (810) 775-0303
Phone(833) 773-8482
Fax(810) 775-0303
Organization SubpartNo
Authorized OfficialLisa A PernaOwner, Authorized Official · (248) 949-7177
Enumeration DateAugust 2, 2021
Last NPPES UpdateMay 5, 20255 updates tracked since enumeration
NPPES CertifiedMay 5, 2025
✔ NPI 1184398331 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
208 W HIGHLAND RD STE 102, Highland, MI 48357
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Other Names 1

Doing Business AsRevival Recovery Center Staffing

Secondary Practice Location 1

Location 15797 Felske Dr Ste 300Brighton, MI 48116-9505 · Phone (833) 773-8482 · Fax (810) 775-0303

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

2

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

Clinicians, nearest first (2)

Lisa Perna, FNP
Nurse Practitioner
NPI 1114298700
208 W HIGHLAND RD STE 102
Highland, MI 48357
(833) 773-8482
✔ PECOS✔ Accepts MedicareSame address
Emily Porzondek, PMHNP
Nurse Practitioner
NPI 1437951217
3111 ELECTRIC AVE
Port Huron, MI 48060
(810) 985-8900
✔ PECOS63 mi

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D2226623

Revival Recovery Center · Highland, MI
Active · expires Jun 28, 2028
CLIA Number23D2226623
Laboratory TypePractitioner Other
Certificate Effective DateJune 29, 2026
Certificate Expiration DateJune 28, 2028
Laboratory DirectorLisa A. Perna
Laboratory Phone(248) 949-7177
Laboratory LocationRevival Recovery Center208 W Highland Road Suite 102, Highland, MI 48357
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Revival Recovery Center Staffing LLC's NPI number?

The NPI number for Revival Recovery Center Staffing LLC is 1184398331. It was assigned to this organization in the NPPES registry on August 2, 2021. The provider is doing business as Revival Recovery Center Staffing.

Where is Revival Recovery Center Staffing LLC located?

Revival Recovery Center Staffing LLC is located at 208 W Highland Rd Ste 102, Highland, MI 48357. The listed phone number is (833) 773-8482.

What is Revival Recovery Center Staffing LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Revival Recovery Center Staffing LLC enrolled in Medicare?

Yes. Revival Recovery Center Staffing LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Revival Recovery Center Staffing LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Revival Recovery Center Staffing LLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Revival Recovery Center Staffing LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D2226623) is associated with this NPI, valid through June 28, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Revival Recovery Center Staffing LLC accept?

Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Revival Recovery Center Staffing LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Revival Recovery Center Staffing LLC was last updated on May 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.