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REVIVAL MENTAL HEALTH LLC
NPI 1922721083
Community Based Residential Treatment Facility, Mental Illness in Fountain Valley, CA

Active since September 23, 2022CLIA 05D2288290 · Waiver
9879 HAMILTON AVE, FOUNTAIN VALLEY, CA 92708(949) 606-4681 Get Directions Write a Review

NPPES record last updated: January 10, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 23, 2023, Sep 23, 2022 (2 updates tracked since 2022).

About Revival Mental Health Llc NPPES

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

REVIVAL MENTAL HEALTH LLC (NPI 1922721083) is a healthcare organization registered as a community based residential treatment facility, mental illness in Fountain Valley, California and active in the NPI registry since September 2022. The organization holds a CLIA Waiver certificate valid through August 22, 2027 and lists Tyler Michaelis, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1922721083
Entity TypeOrganization
Primary Taxonomy320800000X
Legal Business NameREVIVAL MENTAL HEALTH LLC
Location Address9879 HAMILTON AVEFountain Valley, CA 92708-5117
Mailing Address9879 Hamilton AveFountain Valley, CA 92708-5117
Phone(949) 606-4681
Organization SubpartNo
Authorized OfficialTyler MichaelisManaging Member · (949) 606-4681
Enumeration DateSeptember 23, 2022
Last NPPES UpdateJanuary 10, 20242 updates tracked since enumeration
NPPES CertifiedJanuary 10, 2024
✔ NPI 1922721083 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.
9879 HAMILTON AVE, Fountain Valley, CA 92708
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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 05D2288290

Revival Mental Health LLC · Fountain Valley, CA
Active · expires Aug 22, 2027
CLIA Number05D2288290
Laboratory TypeMental Health Trans Facil
Certificate Effective DateAugust 23, 2025
Certificate Expiration DateAugust 22, 2027
Laboratory DirectorAlejandro Alva
Laboratory Phone(949) 866-4553
Laboratory LocationRevival Mental Health LLC9879 Hamilton Ave, Fountain Valley, CA 92708
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 1922721083. It was assigned to this organization in the NPPES registry on September 23, 2022.

Where is Revival Mental Health LLC located?

Revival Mental Health LLC is located at 9879 Hamilton Ave, Fountain Valley, CA 92708. The listed phone number is (949) 606-4681.

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 05D2288290) is associated with this NPI, valid through August 22, 2027. 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.