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REVIVAL MENTAL HEALTH LLC
NPI 1588435325
Community Based Residential Treatment Facility, Mental Illness in Huntington Beach, CA

Active since January 10, 2024CLIA 05D2313615 · Waiver
16252 MAGELLAN LN, HUNTINGTON BEACH, CA 92647(949) 776-9476 Get Directions Write a Review

NPPES record last updated: January 10, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Revival Mental Health Llc NPPES

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

REVIVAL MENTAL HEALTH LLC (NPI 1588435325) is a healthcare organization registered as a community based residential treatment facility, mental illness in Huntington Beach, California and active in the NPI registry since January 2024. The organization holds a CLIA Waiver certificate valid through November 3, 2026 and lists Tyler Michaelis, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1588435325
Entity TypeOrganization
Primary Taxonomy320800000X
Legal Business NameREVIVAL MENTAL HEALTH LLC
Location Address16252 MAGELLAN LNHuntington Beach, CA 92647-3525
Mailing Address16252 Magellan LnHuntington Beach, CA 92647-3525
Phone(949) 776-9476
Organization SubpartNo
Authorized OfficialTyler MichaelisManaging Member · (949) 606-4681
Enumeration DateJanuary 10, 2024
NPPES CertifiedJanuary 10, 2024
✔ NPI 1588435325 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Mental IllnessResidential Treatment Facilities
Taxonomy Code320800000X
Definition

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

16252 MAGELLAN LN, Huntington Beach, CA 92647
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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 05D2313615

Revival Mental Health LLC · Huntington Beach, CA
Active · expires Nov 3, 2026
CLIA Number05D2313615
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateNovember 4, 2024
Certificate Expiration DateNovember 3, 2026
Laboratory DirectorAlejandro Alva
Laboratory Phone(949) 274-3632
Laboratory LocationRevival Mental Health LLC16252 Magellan Ln, Huntington Beach, CA 92647
CLIA data matches this NPI record on: Address Name
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 Mental Health LLC's NPI number?

The NPI number for Revival Mental Health LLC is 1588435325. It was assigned to this organization in the NPPES registry on January 10, 2024.

Where is Revival Mental Health LLC located?

Revival Mental Health LLC is located at 16252 Magellan Ln, Huntington Beach, CA 92647. The listed phone number is (949) 776-9476.

What is Revival Mental Health LLC's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.

Does Revival Mental Health LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2313615) is associated with this NPI, valid through November 3, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Revival Mental Health LLC was last updated on January 10, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.