Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revive Detox

Organization Substance Abuse Rehabilitation Facility · NPI 1639561566

Revive Detox is a Substance Abuse Rehabilitation Facility in Los Angeles, California. Licensed in California. Registered with an NPI since 2015.

Licensed in
CA
In the registry since
2015

Practice location Address checks out

360 N Vista St
Los Angeles, CA 90036-5739
Phone: (818) 462-3824
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Substance Abuse Rehabilitation Facility (primary) Taxonomy 324500000X · Licence 190836AP (CA)

Record details

NPI number1639561566
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Matthew Conley — Program Director · (818) 462-3824
NPI enumeratedMarch 2, 2015
Last updated in NPPESMarch 2, 2015
Mailing address360 N Vista St, Los Angeles, CA 90036-5739

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