REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC
NPI 1699617860
Clinic/Center - Mental Health (Including Community Mental Health Center) in Fort Wayne, IN
About Revivd Recovery And Wellness Fort Wayne Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
REVIVD RECOVERY AND WELLNESS FORT WAYNE LLC (NPI 1699617860) is a healthcare organization registered as a mental health (including community mental health center) in Fort Wayne, Indiana and active in the NPI registry since April 2026. The organization lists Ashley Brown, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Revivd Recovery And Wellness Fort Wayne Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Revivd Recovery And Wellness Fort Wayne LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 Revivd Recovery And Wellness Fort Wayne LLC's NPI number?
The NPI number for Revivd Recovery And Wellness Fort Wayne LLC is 1699617860. It was assigned to this organization in the NPPES registry on April 7, 2026.
Where is Revivd Recovery And Wellness Fort Wayne LLC located?
Revivd Recovery And Wellness Fort Wayne LLC is located at 402 E Main St, Fort Wayne, IN 46802. The listed phone number is (260) 298-8297.
What is Revivd Recovery And Wellness Fort Wayne LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.
Is Revivd Recovery And Wellness Fort Wayne LLC enrolled in Medicare?
Yes. Revivd Recovery And Wellness Fort Wayne LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Revivd Recovery And Wellness Fort Wayne LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Revivd Recovery And Wellness Fort Wayne 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Revivd Recovery And Wellness Fort Wayne LLC was last updated on April 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Revivd Recovery And Wellness Fort Wayne Llc · NPI 1699617860
Mental Health (Including Community Mental Health Center) organization in Fort Wayne, Indiana. Organization record, active in the CMS NPPES registry since April 7, 2026.
## Identity
- **NPI:** 1699617860 (Entity type: Organization)
- **Enumerated:** April 7, 2026
- **Primary specialty:** Clinic/Center - Mental Health (Including Community Mental Health Center) · taxonomy 261QM0801X
- **Organization subpart:** No
- **Authorized official:** Ashley Brown, CEO
## Practice location
- **Address:** 402 E MAIN ST, Fort Wayne, IN 46802-1910
- **Phone:** (260) 298-8297 · **Fax:** (260) 387-6154
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 7, 2026
---
Source: [NPI Profile](https://npiprofile.com/npi/1699617860) · Data from the CMS NPPES public registry.